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Randomized Prospective Trial of Epidural Analgesia after Open Hepatectomy

医学 肝切除术 麻醉 随机对照试验 外科 止痛药 切除术
作者
Vittoria Arslan‐Carlon,Motaz Qadan,Vinay Puttanniah,Kenneth Seier,Mithat Gönen,Gloria Yang,Mary Fischer,Ronald P. DeMatteo,T. Peter Kingham,William R. Jarnagin,Michael I. D’Angelica
出处
期刊:Annals of Surgery [Lippincott Williams & Wilkins]
被引量:2
标识
DOI:10.1097/sla.0000000000006205
摘要

Objective: To evaluate whether patient-controlled epidural analgesia (PCEA) improves postoperative pain during ambulation following elective open hepatectomy. Background: Strategies to alleviate postoperative pain are a critical element of recovery after surgery. However, the optimal postoperative pain management strategy following open hepatectomy remains unclear. Methods: We conducted a prospective, non-blinded, randomized comparison of PCEA (intervention) vs. intravenous patient-controlled analgesia (IV PCA; control) for postoperative pain following elective open hepatectomy. The primary endpoint was pain during ambulation on postoperative day (POD) 2. The study was powered to detect a clinically significant 2-point difference on pain numeric rating scale (NRS). Secondary endpoints included pain at rest, morbidity, time to return of bowel function, and length of stay. Results: From 2015-2020, 231 patients were randomized (116 patients in the PCEA arm and 115 in the IV PCA arm). The incidence of epidural failure was 3% (n=4/116), with no epidural-related complications. Patients in the PCEA arm had a <2 point difference in NRS pain scores during ambulation on POD 2 vs. IV PCA (median 4.0 vs. 5.0, P <0.001). There was no difference in overall complications between the PCEA and IV PCA arms (33% vs. 40%, P =0.276). Secondary outcomes, including pain scores at rest, were similar between the study arms. Conclusions: PCEA was safe following open hepatectomy and was associated with a small difference in pain with activity on POD 2 that did not reach our pre-specified definition of clinical significance.
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