Regional pain management for oesophagectomy: Cohort study suggests a viable alternative to a thoracic epidural to enhance recovery after surgery

Abstract

Ivor Lewis oesophagectomy (ILO) is associated with significant acute postsurgical pain and persistent chronic pain. The purpose of this study was to compare the Concord technique, which involves a combination of a surgeon-inserted paravertebral catheter, a single injection of intrathecal morphine and surgeon-inserted bilateral preperitoneal catheters, with the other available analgesic techniques. The study was designed as a retrospective cohort study and performed at the Concord Repatriation General Hospital, a tertiary teaching hospital affiliated with Sydney University. The participants comprised 60 consecutive patients in whom ILO was undertaken from January 1, 2011 to December 31, 2017, who were retrospectively analysed according to analgesic technique. The maximum, minimum and average pain numerical rating scale (NRS) scores were prospectively recorded daily for 3 days, opioid use for 3 days, and hospital length of stay, intensive care unit (ICU) length of stay, 30-day mortality and postoperative complications were also recorded. The Concord regional anaesthetic technique group had an average NRS pain scores which appeared favourable for day 0 (0.90 vs. 1.42), but no statistical differences were found between either group on day 1 (1.34 vs. 1.54), day 2 (0.94 vs. 1.13) or day 3 (0.94 vs. 1.00). The 30-day mortality, length of stay in hospital and ICU, and postoperative complications were comparable. The Concord regional technique for ILO analgesia appears to provide a simple alternative to other forms of analgesia, with similar analgesic efficacy and with no differences in postoperative complications. This may provide a pathway to enhanced recovery and is suitable to be evaluated in a Randomised control trial (RCT) of techniques.