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Postoperative Pain Relief after Pancreatic Resection: Systematic Review and Meta-Analysis of Analgesic Modalities

Lookup NU author(s): Sanjay PandanaboyanaORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Background This systematic review explored the efficacy of different pain relief modalities used in the management of postoperative pain following pancreatoduodenectomy (PD) and distal pancreatectomy (DP) and impact on peri- operative outcomes.Methods MEDLINE (OVID), Embase, Pubmed, Web of Science and CENTRAL databases were searched using PRISMA framework. Primary outcomes included pain on postoperative day 2 and 4 and respiratory morbidity. Secondary outcomes included operation time, bile leak, delayed gastric emptying, postoperative pancreatic fistula, length of stay, and opioid use.Results Five randomized controlled trials and seven retrospective cohort studies (1313 patients) were included in the systematic review. Studies compared epidural analgesia (EDA) (n = 845), patient controlled analgesia (PCA) (n = 425) and transabdominal wound catheters (TAWC) (n = 43). EDA versus PCA following PD was compared in eight studies (1004 patients) in the quantitative meta-analysis. Pain scores on day 2 (p = 0.19) and 4 (p = 0.18) and respiratory morbidity (p = 0.42) were comparable between EDA and PCA. Operative times, bile leak, delayed gastric emptying, pancreatic fistula, opioid use, and length of stay also were comparable between EDA and PCA. Pain scores and perioperative outcomes were comparable between EDA and PCA following DP and EDA and TAWC following PD. Conclusions EDA, PCA and TAWC are the most frequently used analgesic modalities in pancreatic surgery. Pain relief and other perioperative outcomes are comparable between them. Further larger randomized controlled trials are warranted to explore the relative merits of each analgesic modality on postoperative outcomes with emphasis on postoperative complications.

Publication metadata

Author(s): Akter N, Ratnayake B, Joh D, Chan SJ, Boner E, Pandanaboyana S

Publication type: Article

Publication status: Published

Journal: World Journal of Surgery

Year: 2021

Volume: 45

Pages: 3165-3173

Print publication date: 01/10/2021

Online publication date: 29/06/2021

Acceptance date: 10/06/2021

Date deposited: 08/09/2021

ISSN (print): 0364-2313

ISSN (electronic): 1432-2323

Publisher: Springer


DOI: 10.1007/s00268-021-06217-x

PubMed id: 34185150


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