Guarneri Giovanni, Turi Stefano, Pecorelli Nicolò, Culicchia Giuseppe, Vallorani Alessia, Meani Renato, Beretta Luigi, Falconi Massimo
Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
Health Innovative Products and Technologies (HIP-TECH) PhD Program, Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy.
Updates Surg. 2025 May 30. doi: 10.1007/s13304-025-02268-0.
In the context of enhanced recovery pathways (ERP) for colorectal surgery, thoracic epidural analgesia (TEA) delays recovery compared to opioid-based patient-controlled intravenous analgesia (PCA). Limited evidence is available for laparoscopic pancreatic surgery. The objective of this study was to evaluate the impact of different analgesic modalities on the time to functional recovery (TFR) following laparoscopic distal pancreatectomy (LDP). Clinical data for consecutive patients undergoing LDP were reviewed. All patients were treated within an ERP including a multimodal analgesia protocol. The main analgesic techniques used were TEA, intravenous morphine PCA, and patient-controlled sublingual sufentanil tablet system (SSTS). TFR was defined as postoperative days (PODs) needed to achieve adequate mobilization, return of gastrointestinal function, sufficient oral intake with no need for intravenous infusion, and adequate pain control with oral analgesia. Overall, 336 patients were included; 109 (32%) patients received TEA, 124 (37%) PCA, and 103 (31%) SSTS. TFR was significantly shorter for the SSTS group with median of 4 [IQR 3-5] days compared to 5 [4-6] days in both the TEA and PCA groups (p < 0.001). This difference was due to faster time to sufficient oral intake and adequate pain control with oral analgesia. On POD1, patients treated with TEA had better pain control compared to other modalities; the median NRS pain score at rest was 0 [0-3] compared to 2 [0-4] for both PCA and SSTS groups (p = 0.003). Multivariate regression showed that SSTS was associated with a 17% reduction (95% CI - 29 to - 5; p = 0.005) of TFR compared to TEA. Patients treated with SSTS had a significantly shorter TFR after LDP compared with other analgesic modalities with no difference in adverse events.
在结直肠手术的强化康复路径（ERP）背景下，与基于阿片类药物的患者自控静脉镇痛（PCA）相比，胸段硬膜外镇痛（TEA）会延迟恢复。关于腹腔镜胰腺手术的证据有限。本研究的目的是评估不同镇痛方式对腹腔镜胰体尾切除术（LDP）后功能恢复时间（TFR）的影响。回顾了连续接受LDP患者的临床资料。所有患者均在包含多模式镇痛方案的ERP中接受治疗。主要使用的镇痛技术为TEA、静脉注射吗啡PCA和患者自控舌下舒芬太尼片系统（SSTS）。TFR定义为实现充分活动、胃肠功能恢复、无需静脉输液的充足口服摄入量以及口服镇痛充分控制疼痛所需的术后天数（POD）。总体而言，纳入了336例患者；109例（32%）患者接受TEA，124例（37%）接受PCA，103例（31%）接受SSTS。SSTS组的TFR明显更短，中位数为4[四分位间距3 - 5]天，而TEA组和PCA组均为5[4 - 6]天（p < 0.001）。这种差异是由于达到充足口服摄入量和口服镇痛充分控制疼痛的时间更快。在POD1时，与其他方式相比，接受TEA治疗的患者疼痛控制更好；静息时的数字评分法（NRS）疼痛中位数为0[0 - 3]，而PCA组和SSTS组均为2[0 - 4]（p = 0.003）。多变量回归显示，与TEA相比，SSTS与TFR降低17%相关（95%置信区间 - 29至 - 5；p = 0.005）。与其他镇痛方式相比，接受SSTS治疗的患者在LDP后的TFR明显更短，不良事件无差异。
