Postoperative analgesia for upper gastrointestinal surgery: a retrospective cohort analysis
Authors' conclusion
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.
Study context
- Population
- Patients undergoing open, laparoscopic or laparoscopic converted to open upper gastrointestinal surgery, Royal North Shore Hospital (Sydney, Australia), November 2015–October 2020open 300, laparoscopic 120, converted 7
- Participants
- 427 patients
- Exposure
- Thoracic epidural vs Intrathecal morphine vs Non-neuraxial
- Outcome
- Postoperative oral morphine equivalent consumption and probability of adequate pain control
Methodological detailssingle-centre, Bayesian mixed effect model
- Single-centre
- Bayesian mixed effect model
Main finding
As reported in the abstract
- Intrathecal morphine superior to non-neuraxial analgesia (lower median oral morphine equivalent consumption, higher probability of adequate pain control); effect not sustained beyond POD 2
- Thoracic epidural superior to both intrathecal and non-neuraxial analgesia for both primary outcomes
Observational data: associations, not effects.
Further findings
Neuraxial technique use by surgical approach
- Open surgery: thoracic epidural (n = 174)
- 58%
- Open surgery: intrathecal morphine (n = 63)
- 21%
- Laparoscopic: thoracic epidural (n = 4)
- 3%
- Laparoscopic: intrathecal morphine (n = 14)
- 12%
Safety
- Postoperative hypotension and technique failure with thoracic epidural
- 60% · 113 events
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Postoperative analgesia for upper gastrointestinal surgery: a retrospective cohort analysis. Perioper Med (Lond). Published 18 July 2023. doi:10.
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