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Postoperative analgesia for upper gastrointestinal surgery: a retrospective cohort analysis

BACKGROUND: Thoracic epidural analgesia is commonly used for upper gastrointestinal surgery. Intrathecal morphine is an appealing opioid-sparing non-epidural analgesic option, especially for laparoscopic gastrointestinal surgery. METHODS: Following ethics committee approval, we extracted data from t...

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Autores principales: Pirie, Katrina P., Wang, Andy, Yu, Joanna, Teng, Bao, Doane, Matthew A., Myles, Paul S., Riedel, Bernhard
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10355044/
https://www.ncbi.nlm.nih.gov/pubmed/37464387
http://dx.doi.org/10.1186/s13741-023-00324-0
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author Pirie, Katrina P.
Wang, Andy
Yu, Joanna
Teng, Bao
Doane, Matthew A.
Myles, Paul S.
Riedel, Bernhard
author_facet Pirie, Katrina P.
Wang, Andy
Yu, Joanna
Teng, Bao
Doane, Matthew A.
Myles, Paul S.
Riedel, Bernhard
author_sort Pirie, Katrina P.
collection PubMed
description BACKGROUND: Thoracic epidural analgesia is commonly used for upper gastrointestinal surgery. Intrathecal morphine is an appealing opioid-sparing non-epidural analgesic option, especially for laparoscopic gastrointestinal surgery. METHODS: Following ethics committee approval, we extracted data from the electronic medical records of patients at Royal North Shore Hospital (Sydney, Australia) that had upper gastrointestinal surgery between November 2015 and October 2020. Postoperative morphine consumption and pain scores were modelled with a Bayesian mixed effect model. RESULTS: A total of 427 patients were identified who underwent open (n = 300), laparoscopic (n = 120) or laparoscopic converted to open (n = 7) upper gastrointestinal surgery. The majority of patients undergoing open surgery received a neuraxial technique (thoracic epidural [58%, n = 174]; intrathecal morphine [21%, n = 63]) compared to a minority in laparoscopic approaches (thoracic epidural [3%, n = 4]; intrathecal morphine [12%, n = 14]). Intrathecal morphine was superior over non-neuraxial analgesia in terms of lower median oral morphine equivalent consumption and higher probability of adequate pain control; however, this effect was not sustained beyond postoperative day 2. Thoracic epidural analgesia was superior to both intrathecal and non-neuraxial analgesia options for both primary outcomes, but at the expense of higher rates of postoperative hypotension (60%, n = 113) and substantial technique failure rates (32%). CONCLUSIONS: We found that thoracic epidural analgesia was superior to intrathecal morphine, and intrathecal morphine was superior to non-neuraxial analgesia, in terms of reduced postoperative morphine requirements and the probability of adequate pain control in patients who underwent upper gastrointestinal surgery. However, the benefits of thoracic epidural analgesia and intrathecal morphine were not sustained across all time periods regarding control of pain. The study is limited by its retrospective design, heterogenous group of upper gastrointestinal surgeries and confounding by indication. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13741-023-00324-0.
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spelling pubmed-103550442023-07-20 Postoperative analgesia for upper gastrointestinal surgery: a retrospective cohort analysis Pirie, Katrina P. Wang, Andy Yu, Joanna Teng, Bao Doane, Matthew A. Myles, Paul S. Riedel, Bernhard Perioper Med (Lond) Research BACKGROUND: Thoracic epidural analgesia is commonly used for upper gastrointestinal surgery. Intrathecal morphine is an appealing opioid-sparing non-epidural analgesic option, especially for laparoscopic gastrointestinal surgery. METHODS: Following ethics committee approval, we extracted data from the electronic medical records of patients at Royal North Shore Hospital (Sydney, Australia) that had upper gastrointestinal surgery between November 2015 and October 2020. Postoperative morphine consumption and pain scores were modelled with a Bayesian mixed effect model. RESULTS: A total of 427 patients were identified who underwent open (n = 300), laparoscopic (n = 120) or laparoscopic converted to open (n = 7) upper gastrointestinal surgery. The majority of patients undergoing open surgery received a neuraxial technique (thoracic epidural [58%, n = 174]; intrathecal morphine [21%, n = 63]) compared to a minority in laparoscopic approaches (thoracic epidural [3%, n = 4]; intrathecal morphine [12%, n = 14]). Intrathecal morphine was superior over non-neuraxial analgesia in terms of lower median oral morphine equivalent consumption and higher probability of adequate pain control; however, this effect was not sustained beyond postoperative day 2. Thoracic epidural analgesia was superior to both intrathecal and non-neuraxial analgesia options for both primary outcomes, but at the expense of higher rates of postoperative hypotension (60%, n = 113) and substantial technique failure rates (32%). CONCLUSIONS: We found that thoracic epidural analgesia was superior to intrathecal morphine, and intrathecal morphine was superior to non-neuraxial analgesia, in terms of reduced postoperative morphine requirements and the probability of adequate pain control in patients who underwent upper gastrointestinal surgery. However, the benefits of thoracic epidural analgesia and intrathecal morphine were not sustained across all time periods regarding control of pain. The study is limited by its retrospective design, heterogenous group of upper gastrointestinal surgeries and confounding by indication. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13741-023-00324-0. BioMed Central 2023-07-18 /pmc/articles/PMC10355044/ /pubmed/37464387 http://dx.doi.org/10.1186/s13741-023-00324-0 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Pirie, Katrina P.
Wang, Andy
Yu, Joanna
Teng, Bao
Doane, Matthew A.
Myles, Paul S.
Riedel, Bernhard
Postoperative analgesia for upper gastrointestinal surgery: a retrospective cohort analysis
title Postoperative analgesia for upper gastrointestinal surgery: a retrospective cohort analysis
title_full Postoperative analgesia for upper gastrointestinal surgery: a retrospective cohort analysis
title_fullStr Postoperative analgesia for upper gastrointestinal surgery: a retrospective cohort analysis
title_full_unstemmed Postoperative analgesia for upper gastrointestinal surgery: a retrospective cohort analysis
title_short Postoperative analgesia for upper gastrointestinal surgery: a retrospective cohort analysis
title_sort postoperative analgesia for upper gastrointestinal surgery: a retrospective cohort analysis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10355044/
https://www.ncbi.nlm.nih.gov/pubmed/37464387
http://dx.doi.org/10.1186/s13741-023-00324-0
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