Pain management after robot-assisted minimally invasive esophagectomy

Ann Kristin Rosner; Pieter C van der Sluis; Lena Meyer; Eva Wittenmeier; Kristin Engelhard; Peter P Grimminger; Eva-Verena Griemert

doi:10.1016/j.heliyon.2023.e13842

Pain management after robot-assisted minimally invasive esophagectomy

Heliyon. 2023 Feb 17;9(3):e13842. doi: 10.1016/j.heliyon.2023.e13842. eCollection 2023 Mar.

Authors

Ann Kristin Rosner¹, Pieter C van der Sluis², Lena Meyer¹, Eva Wittenmeier¹, Kristin Engelhard¹, Peter P Grimminger², Eva-Verena Griemert¹

Affiliations

¹ Department of Anesthesiology, University Medical Center Mainz, Germany.
² Department of General, Visceral- and Transplant Surgery, University Medical Center Mainz, Germany.

Abstract

Background: Adequate pain control after open esophagectomy is associated with reduced complications, earlier recovery and higher patient satisfaction. While further developing surgical procedures like robot-assisted minimally invasive esophagectomy (RAMIE) it is relevant to adapt postoperative pain management. The primary question of this observational survey was whether one of the two standard treatments, thoracic epidural analgesia (TEA) or intravenous patient-controlled analgesia (PCA), is superior for pain control after RAMIE as the optimal pain management for these patients still remains unclear. Use of additional analgesics, changes in forced expiratory volume in 1 s (FEV1), postoperative complications and duration of intensive care and hospital stay were also analyzed.

Methods: This prospective observational pilot study analyzed 50 patients undergoing RAMIE (postoperative PCA with piritramide or TEA using bupivacaine; each n = 25). Patient reported pain using the numeric rating scale score and differences in FEV1 using a micro spirometer were measured at postoperative day 1, 3 and 7. Additional data of secondary endpoints were collected from patient charts.

Results: Key demographics, comorbidity, clinical and operative variables were equivalently distributed. Patients receiving TEA had lower pain scores and a longer-lasting pain relief. Moreover, TEA was an independent predictive variable for reduced length of hospital stay (HR -3.560 (95% CI: -6.838 to -0.282), p = 0.034).

Conclusions: Although RAMIE leads to reduced surgical trauma, a less invasive pain therapy with PCA appears to be inferior compared to TEA in case of sufficient postoperative analgesia and length of hospital stay. According to the results of this observational pilot study analgesia with TEA provided better and longer-lasting pain relief compared to PCA. Further randomized controlled trials should be conducted to evaluate the optimal postoperative analgesic treatment for RAMIE.

Keywords: Epidural anesthesia; Esophagectomy; Pain-management; Patient-controlled analgesia; Robotic surgery.