Comparative analysis of analgesic efficacy and functional recovery in open pancreaticoduodenectomy: a randomized controlled trial of local anesthetic wound infiltration, transversus abdominis plane block, and intramuscular electrical stimulation

Hyun-Chang Kim; Jinyoung Park; Hyung Sun Kim; Yeon Hwa Hong; Young Song; Joon Seong Park

doi:10.21037/hbsn-23-650

Comparative analysis of analgesic efficacy and functional recovery in open pancreaticoduodenectomy: a randomized controlled trial of local anesthetic wound infiltration, transversus abdominis plane block, and intramuscular electrical stimulation

Hepatobiliary Surg Nutr. 2024 Dec 1;13(6):950-961. doi: 10.21037/hbsn-23-650. Epub 2024 Jun 18.

Authors

Hyun-Chang Kim^#¹, Jinyoung Park^#², Hyung Sun Kim³, Yeon Hwa Hong¹, Young Song^#¹, Joon Seong Park^#^{3

4}

Affiliations

¹ Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
² Department of Rehabilitation, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
³ Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
⁴ Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.

^# Contributed equally.

Abstract

Background: Pancreaticoduodenectomy (PD) is associated with severe postoperative pain. Optimized pain management can potentially elevate patients' postoperative quality of life. This study focused on comparing the analgesic efficacy and subsequent functional recovery of three techniques, continuous local wound infiltration (LWI), four-quadrant transversus abdominis plane (4QTAP) block, and needle electrical twitch obtaining intramuscular stimulation (NETOIMS), in patients subjected to open PD.

Methods: This is a prospective, single-blinded, randomized controlled study. Among a total of 80 eligible patients, 72 were randomized into the LWI, 4QTAP block, or NETOIMS groups for postoperative pain management. The primary outcome measured was the pain score, which was recorded on postoperative days (PODs) 0, 1, 2, 3, 5, 7, 14, and 28. Additionally, consumption of morphine milligram equivalents (MMEs) and ibuprofen until POD 3 was analyzed. Functional recovery indicators, such as gait speed and peak cough flow (PCF), were assessed on the day before surgery (baseline), and on PODs 2, 7, 14, and 28. A one-way analysis of variance, with subsequent post-hoc Bonferroni analysis, was used to compare these main outcomes.

Results: Out of the 72 patients, 68 (LWI, 22; 4QTAP, 23; NETOIMS 23) were included in the final analysis. Compared to the LWI group, both the 4QTAP block and NETOIMS group demonstrated significantly lower pain scores from PODs 0 through 7 (P<0.001 for POD 0-5; P=0.001 for POD 7, for both groups). The pain scores in the 4QTAP block and NETOIMS groups were comparable across all recorded time points. Up to POD 3, there was a significant reduction in both MMEs (P<0.001) and ibuprofen consumption (P=0.003) in these groups. Additionally, on POD 2, the 4QTAP block and NETOIMS groups exhibited superior PCF (P<0.001) and faster gait speed (P=0.008) compared to the LWI group.

Conclusions: Compared to LWI, both 4QTAP block and NETOIMS were more effective in reducing postoperative pain, necessitated fewer analgesics, and facilitated improved functional recovery after PD.

Trial registration: Clinical Research Information Service of Korea Disease Control and Prevention Agency; cris.nih.go.kr; registration ID: KCT0005814.

Keywords: Pancreaticoduodenectomy (PD); analgesia; intramuscular electrical stimulation; local anesthetics; transversus abdominis plane block.