Randomized prospective trial of epidural analgesia after open hepatectomy Journal Article

   


Authors: Arslan-Carlon, V.; Qadan, M.; Puttanniah, V.; Seier, K.; Gönen, M.; Yang, G.; Fischer, M.; DeMatteo, R. P.; Kingham, T. P.; Jarnagin, W. R.; D'Angelica, M. I.
Article Title: Randomized prospective trial of epidural analgesia after open hepatectomy
Abstract: 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, nonblinded, randomized comparison of PCEA (intervention) versus intravenous patient-controlled analgesia (IV PCA; control) for postoperative pain following elective open hepatectomy. The primary end point was pain during ambulation on postoperative day (POD) 2. The study was powered to detect a clinically significant 2-point difference on the pain numeric rating scale (NRS). Secondary end points included pain at rest, morbidity, time to return of bowel function, and length of stay. Results: From 2015 to 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. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Keywords: adult; controlled study; major clinical study; clinical feature; postoperative period; prospective study; prospective studies; pain; randomized controlled trial; incidence; morbidity; cohort analysis; length of stay; narcotic analgesic agent; hepatectomy; analgesics, opioid; intestine function; epidural analgesia; bupivacaine; hydromorphone; ketorolac; analgesia; patient controlled analgesia; postoperative pain; analgesia, epidural; analgesia, patient-controlled; pain, postoperative; fentanyl; elective surgery; epidural; demographics; mobilization; open surgery; humans; human; article; rest; numeric rating scale
Journal Title: Annals of Surgery
Volume: 279
Issue: 4
ISSN: 0003-4932
Publisher: Lippincott Williams & Wilkins  
Date Published: 2024-04-01
Start Page: 598
End Page: 604
Language: English
DOI: 10.1097/sla.0000000000006205
PUBMED: 38214168
PROVIDER: scopus
PMCID: PMC10939918
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85187198719&doi=10.1097%2fSLA.0000000000006205&partnerID=40&md5=a2512b0259da1106fb489efcb70dab69
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK authors: Vittoria Arslan-Carlon -- Source: Scopus
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MSK Authors
  1. Mary Ellen Fischer
    30 Fischer
  2. Mithat Gonen
    1029 Gonen
  3. Vittoria Arslan-Carlon
    22 Arslan-Carlon
  4. William R Jarnagin
    903 Jarnagin
  5. Michael D'Angelica
    777 D'Angelica
  6. T Peter Kingham
    609 Kingham
  7. Vinay Ganesh Puttanniah
    25 Puttanniah
  8. Kenneth Seier
    105 Seier
  9. Gloria Yang
    16 Yang
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