Negligible Effect of Perioperative Epidural Analgesia Among Patients Undergoing Elective Gastric and Pancreatic Resections

Dhruvil R. Shah, Erin Brown, Jack E. Russo, Chin-Shang Li, Steve R. Martinez, Jodi M. Coates, Richard J Bold, Robert J Canter

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: There are conflicting data regarding improvements in postoperative outcomes with perioperative epidural analgesia. We sought to examine the effect of perioperative epidural analgesia vs. intravenous narcotic analgesia on perioperative outcomes including pain control, morbidity, and mortality in patients undergoing gastric and pancreatic resections. Methods: We evaluated 169 patients from 2007 to 2011 who underwent open gastric and pancreatic resections for malignancy at a university medical center. Emergency, traumatic, pediatric, enucleations, and disseminated cancer cases were excluded. Clinicopathologic data were reviewed among epidural (E) and non-epidural (NE) patients for their association with perioperative endpoints. Results: One hundred twenty patients (71 %) received an epidural and 49 (29 %) did not. There were no significant differences (P > 0. 05) in mean pain scores at each of the four days (days 0-3) among the E (3. 2 ± 2. 7, 3. 2 ± 2. 3, 2. 3 ± 1. 9, and 2. 1 ± 1. 9, respectively) and NE patients (3. 7 ± 2. 7, 3. 4 ± 1. 9, 2. 9 ± 2. 1, and 2. 4 ± 1. 9, respectively). Within each of the E and NE patient groups, there were significant differences (P < 0. 0001) in mean pain scores from day 0 to day 3 (P < 0. 0001). Of the E patients, 69 % also received intravenous patient-controlled analgesia (PCA). Ileus (13 % E vs. 8 % NE), pneumonia (12 % E vs. 8 % NE), venous thromboembolism (6 % E vs. 4 % NE), length of stay [11. 0 ± 12. 1 (8, 4-107) E vs. 12. 2 ± 10. 7 (7, 3-54) NE], overall morbidity (36 % E vs. 39 % NE), and mortality (4 % E vs. 2 % NE) were not significantly different. Conclusions: Routine use of epidurals in this group of patients does not appear to be superior to PCA.

Original languageEnglish (US)
Pages (from-to)660-667
Number of pages8
JournalJournal of Gastrointestinal Surgery
Volume17
Issue number4
DOIs
StatePublished - 2013

Fingerprint

Epidural Analgesia
Stomach
Patient-Controlled Analgesia
Pain
Morbidity
Mortality
Ileus
Narcotics
Venous Thromboembolism
Analgesia
Length of Stay
Neoplasms
Pneumonia
Emergencies
Pediatrics

Keywords

  • Epidural analgesia
  • Morbidity
  • Mortality
  • Upper gastrointestinal surgery

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Negligible Effect of Perioperative Epidural Analgesia Among Patients Undergoing Elective Gastric and Pancreatic Resections. / Shah, Dhruvil R.; Brown, Erin; Russo, Jack E.; Li, Chin-Shang; Martinez, Steve R.; Coates, Jodi M.; Bold, Richard J; Canter, Robert J.

In: Journal of Gastrointestinal Surgery, Vol. 17, No. 4, 2013, p. 660-667.

Research output: Contribution to journalArticle

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title = "Negligible Effect of Perioperative Epidural Analgesia Among Patients Undergoing Elective Gastric and Pancreatic Resections",
abstract = "Background: There are conflicting data regarding improvements in postoperative outcomes with perioperative epidural analgesia. We sought to examine the effect of perioperative epidural analgesia vs. intravenous narcotic analgesia on perioperative outcomes including pain control, morbidity, and mortality in patients undergoing gastric and pancreatic resections. Methods: We evaluated 169 patients from 2007 to 2011 who underwent open gastric and pancreatic resections for malignancy at a university medical center. Emergency, traumatic, pediatric, enucleations, and disseminated cancer cases were excluded. Clinicopathologic data were reviewed among epidural (E) and non-epidural (NE) patients for their association with perioperative endpoints. Results: One hundred twenty patients (71 {\%}) received an epidural and 49 (29 {\%}) did not. There were no significant differences (P > 0. 05) in mean pain scores at each of the four days (days 0-3) among the E (3. 2 ± 2. 7, 3. 2 ± 2. 3, 2. 3 ± 1. 9, and 2. 1 ± 1. 9, respectively) and NE patients (3. 7 ± 2. 7, 3. 4 ± 1. 9, 2. 9 ± 2. 1, and 2. 4 ± 1. 9, respectively). Within each of the E and NE patient groups, there were significant differences (P < 0. 0001) in mean pain scores from day 0 to day 3 (P < 0. 0001). Of the E patients, 69 {\%} also received intravenous patient-controlled analgesia (PCA). Ileus (13 {\%} E vs. 8 {\%} NE), pneumonia (12 {\%} E vs. 8 {\%} NE), venous thromboembolism (6 {\%} E vs. 4 {\%} NE), length of stay [11. 0 ± 12. 1 (8, 4-107) E vs. 12. 2 ± 10. 7 (7, 3-54) NE], overall morbidity (36 {\%} E vs. 39 {\%} NE), and mortality (4 {\%} E vs. 2 {\%} NE) were not significantly different. Conclusions: Routine use of epidurals in this group of patients does not appear to be superior to PCA.",
keywords = "Epidural analgesia, Morbidity, Mortality, Upper gastrointestinal surgery",
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T1 - Negligible Effect of Perioperative Epidural Analgesia Among Patients Undergoing Elective Gastric and Pancreatic Resections

AU - Shah, Dhruvil R.

AU - Brown, Erin

AU - Russo, Jack E.

AU - Li, Chin-Shang

AU - Martinez, Steve R.

AU - Coates, Jodi M.

AU - Bold, Richard J

AU - Canter, Robert J

PY - 2013

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N2 - Background: There are conflicting data regarding improvements in postoperative outcomes with perioperative epidural analgesia. We sought to examine the effect of perioperative epidural analgesia vs. intravenous narcotic analgesia on perioperative outcomes including pain control, morbidity, and mortality in patients undergoing gastric and pancreatic resections. Methods: We evaluated 169 patients from 2007 to 2011 who underwent open gastric and pancreatic resections for malignancy at a university medical center. Emergency, traumatic, pediatric, enucleations, and disseminated cancer cases were excluded. Clinicopathologic data were reviewed among epidural (E) and non-epidural (NE) patients for their association with perioperative endpoints. Results: One hundred twenty patients (71 %) received an epidural and 49 (29 %) did not. There were no significant differences (P > 0. 05) in mean pain scores at each of the four days (days 0-3) among the E (3. 2 ± 2. 7, 3. 2 ± 2. 3, 2. 3 ± 1. 9, and 2. 1 ± 1. 9, respectively) and NE patients (3. 7 ± 2. 7, 3. 4 ± 1. 9, 2. 9 ± 2. 1, and 2. 4 ± 1. 9, respectively). Within each of the E and NE patient groups, there were significant differences (P < 0. 0001) in mean pain scores from day 0 to day 3 (P < 0. 0001). Of the E patients, 69 % also received intravenous patient-controlled analgesia (PCA). Ileus (13 % E vs. 8 % NE), pneumonia (12 % E vs. 8 % NE), venous thromboembolism (6 % E vs. 4 % NE), length of stay [11. 0 ± 12. 1 (8, 4-107) E vs. 12. 2 ± 10. 7 (7, 3-54) NE], overall morbidity (36 % E vs. 39 % NE), and mortality (4 % E vs. 2 % NE) were not significantly different. Conclusions: Routine use of epidurals in this group of patients does not appear to be superior to PCA.

AB - Background: There are conflicting data regarding improvements in postoperative outcomes with perioperative epidural analgesia. We sought to examine the effect of perioperative epidural analgesia vs. intravenous narcotic analgesia on perioperative outcomes including pain control, morbidity, and mortality in patients undergoing gastric and pancreatic resections. Methods: We evaluated 169 patients from 2007 to 2011 who underwent open gastric and pancreatic resections for malignancy at a university medical center. Emergency, traumatic, pediatric, enucleations, and disseminated cancer cases were excluded. Clinicopathologic data were reviewed among epidural (E) and non-epidural (NE) patients for their association with perioperative endpoints. Results: One hundred twenty patients (71 %) received an epidural and 49 (29 %) did not. There were no significant differences (P > 0. 05) in mean pain scores at each of the four days (days 0-3) among the E (3. 2 ± 2. 7, 3. 2 ± 2. 3, 2. 3 ± 1. 9, and 2. 1 ± 1. 9, respectively) and NE patients (3. 7 ± 2. 7, 3. 4 ± 1. 9, 2. 9 ± 2. 1, and 2. 4 ± 1. 9, respectively). Within each of the E and NE patient groups, there were significant differences (P < 0. 0001) in mean pain scores from day 0 to day 3 (P < 0. 0001). Of the E patients, 69 % also received intravenous patient-controlled analgesia (PCA). Ileus (13 % E vs. 8 % NE), pneumonia (12 % E vs. 8 % NE), venous thromboembolism (6 % E vs. 4 % NE), length of stay [11. 0 ± 12. 1 (8, 4-107) E vs. 12. 2 ± 10. 7 (7, 3-54) NE], overall morbidity (36 % E vs. 39 % NE), and mortality (4 % E vs. 2 % NE) were not significantly different. Conclusions: Routine use of epidurals in this group of patients does not appear to be superior to PCA.

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KW - Morbidity

KW - Mortality

KW - Upper gastrointestinal surgery

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