P-0123 - Post Operative Pain Management in Whipples' Procedure -Epidural Analgesia Versus Intravenous Analgesia

Abstract

Introduction: This study evaluated best palliation of pain management by two procedures –Epidural analgesia versus intravenous analgesia of 62 patients of pancreatic carcinoma who underwent uncomplicated surgeries of more than 3 hours duration between 2009 and 2012. The management of severe post-operative pain in patients of cancer surgery may be problematic. Parenterally administered opioids remain the cornerstone of treatment for mild to moderate pain, while epidural routes should be considered for post-operative patients who require rapid onset of analgesia and whose dose requirements cannot be properly titrated. The use of intravenous fentanyl analgesia is attractive for the management of post-operative pain but patients of general anaesthesia receiving supplemental epidural anesthesia and analgesia experienced faster recovery in the post-operative period.Methods: For post-operative pain management patients received either epidural analgesia (EA group) with 0.125% bupivacaine and 0.5% fentanyl sulfate or parenteral fentanyl therapy via intravenous analgesia as per patients demand after balanced general anesthesia. Patients in both the EA (n = 34) and IV (n = 28) groups were compared for demographics, length of surgical intensive care unit (SICU) and hospital stays. Intensity of pain was compared with visual analogue scale (VAS).Results: Demographically both groups were comparable. All patients reported adequate dynamic pain control as evaluated with visual analog pain scores (VAS < 4/10), during the treatment periods (5 +/- 3 versus 5 +/- 2 days, EA versus IV analgesia). All patients were admitted to the SICU after the operation. Patients in the EA group required less ventilator support than did those in the IV-PCA group (0.5 +/- 0.8 versus 1.2 +/- 0.9 days, P < .05). Patients in the EA group also spent less time in both the SICU (1.3 +/- 0.8 versus 2.8 +/- 0.6 days, P < .05) and in the hospital (11 +/- 3 versus 17 +/- 5 days, P < .05) than did their counterparts in the IV-PCA group.Conclusion: The use of both analgesic techniques was associated with satisfactory postoperative pain control. However, patients receiving epidural anesthesia and analgesia experienced faster recovery as judged by shorter mechanical ventilation time, and decreased SICU and hospital stays, resulting in significantly lower hospitalization costs. The use of perioperative epidural techniques should be considered to expedite recovery of surgical patients, and has the added benefit of being cost effective by reducing hospital stays. Introduction: This study evaluated best palliation of pain management by two procedures –Epidural analgesia versus intravenous analgesia of 62 patients of pancreatic carcinoma who underwent uncomplicated surgeries of more than 3 hours duration between 2009 and 2012. The management of severe post-operative pain in patients of cancer surgery may be problematic. Parenterally administered opioids remain the cornerstone of treatment for mild to moderate pain, while epidural routes should be considered for post-operative patients who require rapid onset of analgesia and whose dose requirements cannot be properly titrated. The use of intravenous fentanyl analgesia is attractive for the management of post-operative pain but patients of general anaesthesia receiving supplemental epidural anesthesia and analgesia experienced faster recovery in the post-operative period. Methods: For post-operative pain management patients received either epidural analgesia (EA group) with 0.125% bupivacaine and 0.5% fentanyl sulfate or parenteral fentanyl therapy via intravenous analgesia as per patients demand after balanced general anesthesia. Patients in both the EA (n = 34) and IV (n = 28) groups were compared for demographics, length of surgical intensive care unit (SICU) and hospital stays. Intensity of pain was compared with visual analogue scale (VAS). Results: Demographically both groups were comparable. All patients reported adequate dynamic pain control as evaluated with visual analog pain scores (VAS < 4/10), during the treatment periods (5 +/- 3 versus 5 +/- 2 days, EA versus IV analgesia). All patients were admitted to the SICU after the operation. Patients in the EA group required less ventilator support than did those in the IV-PCA group (0.5 +/- 0.8 versus 1.2 +/- 0.9 days, P < .05). Patients in the EA group also spent less time in both the SICU (1.3 +/- 0.8 versus 2.8 +/- 0.6 days, P < .05) and in the hospital (11 +/- 3 versus 17 +/- 5 days, P < .05) than did their counterparts in the IV-PCA group. Conclusion: The use of both analgesic techniques was associated with satisfactory postoperative pain control. However, patients receiving epidural anesthesia and analgesia experienced faster recovery as judged by shorter mechanical ventilation time, and decreased SICU and hospital stays, resulting in significantly lower hospitalization costs. The use of perioperative epidural techniques should be considered to expedite recovery of surgical patients, and has the added benefit of being cost effective by reducing hospital stays.