Comparison of methods of analgesia in patients after pancreatic surgery: a cohort retrospective study

AIM: To compare the effectiveness of postoperative analgesia by methods of epidural blockade (EB) and rectus sheath block (RSB) in the early postoperative period in patients who underwent pancreatic surgery.

MATERIALS AND METHODS: A retrospective analysis of inpatient case histories of patients after pancreatic surgery at JSC Ilyinsky Hospital for the period from 2019 to 2021 (n=92) was conducted. For the study, 78 cases were selected, which were divided into two groups: the first group (n=46) received EB with a local anesthetic in the postoperative period, and the second group (n=32) underwent RSB followed by the introduction of a local anesthetic solution.

RESULTS:The level of pain on the visual analog scale was statistically significantly higher in the first group on day 1(1.07 [0.50–1.80] and 0.48 [0.08–1.13], respectively, p=0.013) and day 2 (0.82 [0.25–1.33] and 0.33 [0.06–0.75], respectively, p=0.021), and no differences were found on day 3 (p=0.060). The frequency of additional use of opioid analgesia did not differ between the study groups (day 1, p=0.233; day 2, p=0.570; and day 3, p=0.092 The use of norepinephrine infusion in the early postoperative period (p=0.842), daily and cumulative water balance (day 0, p=0.851; day 1, p=0.883; and day 2, p=0.319; day 3, p=0.718; and cumulative balance, p=0.707), and verticalization time (p=0.800) also showed no significant difference.). Orthostatic reactions during early mobilization were noted significantly more often in the EB group than in the RSB group (n=10, 21.7%; n=1, 3.2%, respectively; OR 8.333, 95% CI 1.008–66.667, p=0.042). The appearance of the first stool was more common in the EB group (3 [2–4] days vs. 4 [3–5] days in the RSB group, p=0.027). No statistically significant difference was found between the groups in the development of infectious complications (p=1.000), gastrostasis (p=0.144), in-hospital mortality rate (p=0.460), ICU days (p=0.305), and lengths of stay (p=0.776).

CONCLUSION: The data obtained in the study show the comparability of the use of analgesia methods, such as EB and RSB in patients who underwent pancreatic surgery.