The clinical impact of the perioperative epidural anesthesia on surgical outcomes after pancreaticoduodenectomy: A retrospective cohort study

Negrini, Daniel; Ihsan, Mayan; Freitas, Karine Marques Lento de; Pollazzon, Caroline; Graaf, Jacqueline; Andre, Jorge; Linhares, Tatiana; Brandao, Virna; Silva, Gustavo; Fiorelli, Rossano Kepler Alvim; Barone, Patrick

doi:10.1016/j.sopen.2022.07.004

Cited by 5 publications

(2 citation statements)

References 29 publications

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“…Excessive fluid administration and vasopressors associated with EA contribute to postoperative morbidity, including impairment of enteric anastomosis [16,[19][20][21][22]. The clinical benefit of EA in terms of reduced morbidity and mortality is not so conclusive [12,[23][24][25][26][27].…”

Section: Introductionmentioning

confidence: 99%

Analgesic Modalities in Patients Undergoing Open Pancreatoduodenectomy—A Systematic Review and Meta-Analysis

Mărgărit,

Bartoș,

Laza

et al. 2023

JCM

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Background: This systematic review explored the efficacy of different analgesic modalities and the impact on perioperative outcome in patients undergoing pancreatoduodenectomy. Methods: A systematic literature search was performed on PubMed, Embase, Web of Science, Scopus, and Cochrane Library Database using the PRISMA framework. The primary outcome was pain scores on postoperative day one (POD1) and postoperative day two (POD2). The secondary outcomes included length of hospital stay (LOS) and specific procedure-related complications. Results: Five randomized controlled trials and ten retrospective cohort studies were included in the systematic review. Studies compared epidural analgesia (EA), patient-controlled analgesia (PCA), continuous wound infiltration (CWI), continuous bilateral thoracic paravertebral infusion (CTPVI), intrathecal morphine (ITM), and sublingual sufentanil. The pain scores on POD1 (p < 0.001) and POD2 (p = 0.05) were higher in the PCA group compared with the EA group. Pain scores were comparable between EA and CWI plus PCA or CTPVI on POD1 and POD2. Pain scores were comparable between EA and ITM on POD1. The procedure-related complications and length of hospital stay were not significantly different according to the type of analgesia. Conclusions: EA provided lower pain scores compared with PCA on the first postoperative day after pancreatoduodenectomy; the length of hospital stay and procedure-related complications were similar between EA and PCA. CWI and CTPVI provided similar pain relief to EA.

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Section: Introductionmentioning

confidence: 99%

Analgesic Modalities in Patients Undergoing Open Pancreatoduodenectomy—A Systematic Review and Meta-Analysis

Mărgărit,

Bartoș,

Laza

et al. 2023

JCM

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“…The multimodal pain management strategy includes use of regional blocks, thoracic epidurals and morphine spinals as adjuncts in the peri-operative period. Literature shows a reduction in post-operative complications in patients who received a thoracic epidural as part of their pain management compared to those who did not, with these patients having a reduced incidence of respiratory depression, ileus, pneumonia and decreased risk of death (17). Current ERAS guidelines recommends that mid-thoracic epidural between nerve roots T5 and T8 be used for both intraoperative and postoperative pain management (14) The surgical volume, patient demographics, intraoperative techniques and outcomes of patients presenting for Whipple's procedure at Charlotte Maxeke Johannesburg academic (CMJAH) is not documented.…”

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confidence: 99%

The Perioperative Management of Patients Presenting for Whipple’s Procedure at an Academic Institution

Mohatla,

Marumo,

Dingezweni

2024

Preprint

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Background The Whipple’s procedure or pancreaticoduodenectomy is the primary treatment method of pancreatic cancer and more recently for other benign and cancerous lesions of the periampullary region. The procedure has associated with high mortality and morbidity rates since its inception but with improving surgical techniques and peri-operative care, these have improved over the decades. Our aims were to describe perioperative patient demographic profile, surgical indications, intra-operative surgical and anaesthetic techniques for Whipple’s procedure and their impact on patient outcomes in our centre. Methods A review of patients database over a 10-year period (01 January 2012 to 31 December 2022) at Charlotte Maxeke Johannesburg Academic Hospital was performed. The data was collected using a RedCap® collection tool developed by the researchers based on previous studies. The patient profile, preoperative clinical presentations, surgical indications, intra-operative surgical findings and intraoperative anaesthetic techniques were collected. Post operative data on length of intensive care unit stay, hospital stay, morbidity and mortality were also collected. Data was analysed using the Statistical Product and Services Solutionsystem. Results A total of 50 Whipple’s procedures were performed over the 10-year period, with the male gender at 58% and overall median patient age of 53 years. The main presenting symptom was jaundice with major surgical indication in this cohort being head of pancreas mass. Open procedure dominated surgical technique with an average surgical time of 552 minutes. All procedures were done under general anaesthesia and neuraxial analgesic technique favoured in addition to intravenous analgesics. Post-operatively, average length of ICU stay was 5.4 days and average length of hospital stay was 17 days. Intra-abdominal collection was the most observed complication. Liberal crystalloids use was associated with significantly longer ICU stays (p-value = 0.009) and bile leak. Blood transfusions were associated with wound sepsis and development of acute kidney injury. Mortality rate was 26%. Conclusions The lower volume of Whipple’s procedures performed yearly at CMJAH may be the reason for the observed higher mortality and morbidity rates than those seen in developed countries. In keeping with current literature, liberal crystalloids and blood transfusions were associated with post-operative complications.

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How I do it. Pancreatojejunostomy: surgical tips to mitigate the severity of postoperative pancreatic fistulas after open or minimally invasive pancreatoduodenectomy

Machado,

Machado

2024

Updates Surg

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The clinical impact of the perioperative epidural anesthesia on surgical outcomes after pancreaticoduodenectomy: A retrospective cohort study

Cited by 5 publications

References 29 publications

Analgesic Modalities in Patients Undergoing Open Pancreatoduodenectomy—A Systematic Review and Meta-Analysis

Analgesic Modalities in Patients Undergoing Open Pancreatoduodenectomy—A Systematic Review and Meta-Analysis

The Perioperative Management of Patients Presenting for Whipple’s Procedure at an Academic Institution

How I do it. Pancreatojejunostomy: surgical tips to mitigate the severity of postoperative pancreatic fistulas after open or minimally invasive pancreatoduodenectomy

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