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Association between intraoperative and postoperative epidural or intravenous patient-controlled analgesia and pancreatic fistula after distal pancreatectomy

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Abstract

Purpose

This study aimed to elucidate the association between postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) and clinicopathological factors and intraoperative and postoperative epidural or intravenous patient-controlled analgesia (IV-PCA).

Methods

We reviewed data of 116 patients who underwent distal pancreatectomy at Gunma University Hospital from October 2000 to October 2019. Clinical POPF was defined as the International Study Group of Pancreatic Fistula grade B or C.

Results

Intraoperative and postoperative analgesia included fentanyl-mediated IV-PCA (n = 37, 32%), fentanyl-mediated epidural analgesia (n = 39, 34%), and morphine-mediated epidural analgesia (n = 40, 34%). All patients had received analgesia. Clinical POPF occurred in 34 of the 116 (29%) DP cases. Male sex (P = 0.035) and the length of operation time (P = 0.0070) were significant risk factors of clinical POPF. Furthermore, a thick pancreas was more likely to cause clinical POPF than a thin one (P = 0.052). No statistically significant difference was found between other factors, including intraoperative and postoperative analgesia (P = 0.95), total median oral morphine equivalents (P = 0.23), and clinical POPF.

Conclusion

Intraoperative and postoperative epidural analgesia and IV-PCA are not associated with clinical POPF after DP. Our results suggest that morphine and fentanyl can be used as IV-PCA or epidural analgesia.

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Acknowledgements

We thank Ms. Tomoko Ubukata, Ms. Harumi Kanai, and Ms. Misato Negishi for their excellent assistance.

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Authors and Affiliations

  1. Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan

    Takamichi Igarashi, Norifumi Harimoto, Ryo Muranushi, Takahiro Yamanaka, Kei Hagiwara, Kouki Hoshino, Norihiro Ishii, Mariko Tsukagoshi, Akira Watanabe, Norio Kubo, Kenichiro Araki & Ken Shirabe

  2. Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan

    Yusuke Matsui & Shigeru Saito

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  1. Takamichi Igarashi
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Correspondence to Norifumi Harimoto.

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Igarashi, T., Harimoto, N., Matsui, Y. et al. Association between intraoperative and postoperative epidural or intravenous patient-controlled analgesia and pancreatic fistula after distal pancreatectomy. Surg Today 51, 276–284 (2021). https://doi.org/10.1007/s00595-020-02087-3

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  • DOI: https://doi.org/10.1007/s00595-020-02087-3

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