Lattimore Courtney M, Kane William J, Sarosiek Bethany M, Coleman Christy M, Turrentine Florence E, Forkin Katherine T, Bauer Todd W, Adams Reid B, Zaydfudim Victor M
Department of Surgery, University of Virginia Health System, P.O. Box 800709, Charlottesville, VA, 22908, USA; Surgical Outcomes Research Center, University of Virginia Health System, P.O. Box 800709, Charlottesville, VA, 22908, USA. Electronic address: https://twitter.com/cmlattimore.
Department of Surgery, University of Virginia Health System, P.O. Box 800709, Charlottesville, VA, 22908, USA; Surgical Outcomes Research Center, University of Virginia Health System, P.O. Box 800709, Charlottesville, VA, 22908, USA. Electronic address: https://twitter.com/wjkane.
HPB (Oxford). 2022 Nov;24(11):1930-1936. doi: 10.1016/j.hpb.2022.06.002. Epub 2022 Jun 16.
Efficacy of single-shot opioid spinal analgesia after pancreatoduodenectomy remains understudied and lacks comparison to standard continuous thoracic epidural analgesia (TEA).
Pancreatoduodenectomy patients who underwent TEA or opioid spinal for postoperative pain management from 2015 to 2020 were included in this observational cohort study. Primary outcome was patient-reported mean daily pain scores. Secondary outcomes included postoperative morphine milligram equivalents (MMEs) and length of stay (LOS). Multivariable linear regression models were constructed to compare risk-adjusted outcomes.
180 patients were included: 56 TEA and 124 opioid spinal. Compared to epidural patients, opioid spinal patients were more likely to be older (67.0 vs. 64.6, p=0.045), have greater BMI (26.5 vs. 24.4, p=0.02), and less likely to be smokers (19.4% vs. 41.1%, p=0.002). Opioid spinal, compared to TEA, was associated with lower intraoperative MMEs (0.25 vs. 22.7, p<0.001) and postoperative daily MMEs (7.9 vs. 10.3, p=0.03) on univariate analysis. However, after multivariable adjustment, there was no difference in average pain scores across the postoperative period (spinal vs. epidural: 4.18 vs. 4.14, p=0.93), daily MMEs (p=0.50), or LOS (p=0.23).
There was no significant difference in postoperative pain scores, opioid use, or LOS between patients managed with TEA or opioid spinal after pancreatoduodenectomy.
胰十二指肠切除术后单次注射阿片类药物脊髓镇痛的疗效仍未得到充分研究，且缺乏与标准持续胸段硬膜外镇痛（TEA）的比较。
本观察性队列研究纳入了2015年至2020年期间接受TEA或阿片类药物脊髓镇痛进行术后疼痛管理的胰十二指肠切除术患者。主要结局是患者报告的平均每日疼痛评分。次要结局包括术后吗啡毫克当量（MME）和住院时间（LOS）。构建多变量线性回归模型以比较风险调整后的结局。
共纳入180例患者：56例接受TEA，124例接受阿片类药物脊髓镇痛。与硬膜外镇痛患者相比，阿片类药物脊髓镇痛患者年龄更大（67.0对64.6，p=0.045）、体重指数更高（26.5对24.4，p=0.02），且吸烟的可能性更小（19.4%对41.1%，p=0.002）。单因素分析显示，与TEA相比，阿片类药物脊髓镇痛与术中较低的MME（0.25对22.7，p<0.001）和术后每日较低的MME（7.9对10.3，p=0.03）相关。然而，经过多变量调整后，术后期间的平均疼痛评分（脊髓镇痛对硬膜外镇痛：4.18对4.14，p=0.93）、每日MME（p=0.50）或LOS（p=0.23）没有差异。
胰十二指肠切除术后接受TEA或阿片类药物脊髓镇痛的患者在术后疼痛评分、阿片类药物使用或LOS方面没有显著差异。
