A new treatment modality for the postoperative muscular pain management in pylorus preserving pancreaticoduodenectomy: a double-blind randomized control trial

Abstract

Introduction: Pylorus preserving pancreaticoduodenectomy (PPPD) is a treatment for the resectable tumor or cancer in pancreaticoduodenal system. In open surgery, incision and suture of the abdominal muscles cause the inflammatory changes, strain, muscular pain which deteriorates the postoperative quality of life. We therefore suggest electrical twitch obtaining intramuscular stimulation (ETOIMS) as a new treatment modality for pain control after PPPD. Method: Between June 2018 and January 2019, among the patients who underwent PPPD in Department of Surgery, participated 45 patients were randomly assigned to two groups. The group 2 received ETOIMS right after surgery under the general anesthesia. ETOIMS was conducted on each patient using Clavis (Alpine Biomed ApS, Denmark). Aseptic monopolar needle electrode was inserted into the transverse abdominis muscle under ultrasound guidance. The pain score (visual analogue scale, VAS), peak cough flow (PCF), gait speed was compared with proportion to the preoperative values. The 3 main outcomes were analyzed by linear mixed model or repeated measures ANOVA using SPSS 23.0. Result: The pain score was highest on the day of surgery (Group 1: 6.5 ± 2.2, Group 2: 5.5±1.9, P = 0.17) and decreased gradually. Through the course of pain relieving, the pain scores were significantly lower in Group 2 after PPPD (P = 0.01). Although the PCF at each measuring time points didn’t show the group difference (P = 0.20), the improved PCF from the second day of surgery to discharge was greater in Group 2 (P = 0.02). Although the gait speeds at each time point were not significantly different, the time course of improving gait speed was significantly faster in Group 2 (P < 0.01). Conclusion: The ETOIMS is helpful in fast reducing postoperative somatic pain developed after PPPD, and also helpful in fast improvement of PCF and gait speed.