Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
J Hepatobiliary Pancreat Sci. 2023 Apr;30(4):523-531. doi: 10.1002/jhbp.1216. Epub 2022 Jul 15.
BACKGROUND/PURPOSE: Risk-stratified pancreatectomy clinical pathways using regional anesthesia and multimodality analgesia have decreased overall opioid use, but the additional benefits of robotic surgery in opioid reduction for pancreatoduodenectomy (PD) are unknown. We compared the inpatient opioid use between robotic PD and open PD.
Patients undergoing open PD within a protocol evaluating preincisional regional anesthetic block bundles were compared to consecutively-treated patients undergoing robotic PD identified from a prospectively maintained single-institutional database. Clinical characteristics, operative outcomes, pain scores and inpatient oral morphine equivalent (OME) use were compared between patients treated with robotic or open PD. Patients with a history of continuous-release opioid dependence were excluded.
Of 114 total patients, 25 underwent robotic PD and 89 underwent open PD. Intraoperative opioid use was not different (P = .87), nor were cumulative pain scores. Robotic PD patients used significantly fewer OMEs per day on postoperative days 1-4 (P = .039), used fewer total OMEs during hospitalization (robotic: median = 79, IQR 42.5-141; open: median = 126, IQR 61.3-203.8; P = .0036) and were discharged with fewer OMEs (robotic: median = 0, IQR 0-43.8; open: median = 25, IQR 0-75; P = .009) despite a shorter length of stay (robotic: median = 4, open: median = 5, P = .002).
Robotic PD patients required fewer inpatient OMEs than open PD while maintaining similar pain scores. A higher percentage of robotic PD patients tapered off of opioids prior to discharge than open surgery patients treated with a standardized opioid reduction protocol despite a shorter length of stay. These results provide a rationale for choosing robotic PD when feasible to minimize opioid use.
背景/目的：使用区域麻醉和多模式镇痛的风险分层胰切除术临床路径已减少了整体阿片类药物的使用，但机器人手术在减少胰十二指肠切除术（PD）阿片类药物方面的额外益处尚不清楚。我们比较了机器人 PD 和开放 PD 之间的住院阿片类药物使用情况。
在评估预切开区域麻醉阻滞包的方案中接受开放 PD 的患者与从前瞻性维护的单机构数据库中连续治疗的接受机器人 PD 的患者进行比较。比较机器人或开放 PD 治疗患者的临床特征、手术结果、疼痛评分和住院口服吗啡当量（OME）使用情况。排除有持续释放阿片类药物依赖史的患者。
在 114 例患者中，25 例接受机器人 PD，89 例接受开放 PD。术中阿片类药物使用无差异（P=0.87），累积疼痛评分也无差异。机器人 PD 患者在术后第 1-4 天每天使用的 OME 明显较少（P=0.039），住院期间使用的 OME 总量也较少（机器人：中位数=79，IQR 42.5-141；开放：中位数=126，IQR 61.3-203.8；P=0.0036），出院时 OME 用量也较少（机器人：中位数=0，IQR 0-43.8；开放：中位数=25，IQR 0-75；P=0.009），尽管住院时间较短（机器人：中位数=4，开放：中位数=5，P=0.002）。
机器人 PD 患者需要的住院 OME 少于开放 PD，同时保持相似的疼痛评分。尽管住院时间较短，但与接受标准化阿片类药物减少方案的开放手术患者相比，机器人 PD 患者中有更高比例的患者在出院前停用阿片类药物。这些结果为在可行的情况下选择机器人 PD 以最大程度减少阿片类药物使用提供了依据。
