Epidural versus transabdominal wound catheters for postoperative analgesia following pancreatic surgery: A comparative study

Abstract

Background: Pancreatic surgery is typically performed with epidural analgesia; however there is paucity of data to support this as best practice. This study compared the use of epidural analgesia to local anaesthetic administration via trans-abdominal wound catheter (TAWC), to determine the effect on perioperative outcomes. Methods: A Retrospective review of patients undergoing open pancreatic surgery at Auckland City Hospital from January 2015 to December 2018 was undertaken. Data collected included demographics, method of perioperative analgesia, intravenous fluid and vasopressor use, length of HDU and hospital stay and post-operative complications. Data was analysed using unpaired Wilcoxon tests and Fisher Exact test. Results: Seventy two patients underwent pancreatic surgery (n=62; pancreatoduodenectomy, n=10; distal pancreatectomy). The median age was 64. 47 patients had epidural analgesia and 25 patients TAWC. There was no significant difference between the two groups in terms of volume of IV fluid given or need for vasopressors in the first three days, length of HDU stay (median 1 day, p=0.28), rates of post-operative pancreatic fistula (32 vs 40%, p=0.60), post-operative complications (38 vs. 20%, p=0.18) or death (0.04 vs 0.04%, p=1). Epidural patients tended towards having higher rates of day 0 vasopressor use (62 vs 40%, p=0.0891) and longer hospital stays (16 vs 12 days, p=0.07737), however this did not reach statistical significance. Conclusions: Epidural analgesia and TAWC had comparable perioperative outcomes in patients undergoing pancreatic surgery. Further randomised studies with a larger cohort of patients are warranted to identify the best postoperative analgesic method in this cohort of patients.