Epidural and Non-epidural Analgesia in Patients Undergoing Open Pancreatectomy: a Retrospective Cohort Study

BACKGROUND: The use of epidural analgesia (EA) in pancreatic surgery remains under debate. This study compares patients treated with EA versus non-EA after open pancreatectomy in a tertiary referral center. METHODS: All patients undergoing open pancreatectomy from 2013 to 2017 were retrospectively reviewed. (Non-)EA was terminated on postoperative day (POD) 3 or earlier if required. RESULTS: In total, 190 (72.5%) patients received EA and 72 (27.5%) patients received non-EA (mostly intravenous morphine). EA was terminated prematurely in 32.6% of patients and non-EA in 10.5% of patients. Compared with non-EA patients, EA patients had significantly lower pain scores on POD 0 (1.10 (0–3.00) versus 3.00 (1.67–5.00), P < 0.001) and POD 1 (2.00 (0.50–3.41) versus 3.00 (2.00–3.80), P = 0.001), though significantly higher pain scores on POD 3 (3.00 (2.00–4.00) versus 2.33 (1.50–4.00), P < 0.001) and POD 4 (2.50 (1.50–3.67) versus 2.00 (0.50–3.00), P = 0.007). EA patients required more vasoactive medication perioperatively and had higher cumulative fluid balances on POD 1–3. Postoperative complications were similar between groups. CONCLUSIONS: In our cohort, patients with EA experienced significantly lower pain scores in the first PODs compared with non-EA, yet higher pain scores after EA had been terminated. Although EA patients required more vasoactive medication and fluid therapy, the complication rate was similar. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11605-019-04136-w) contains supplementary material, which is available to authorized users.