The clinical impact of the perioperative epidural anesthesia on surgical outcomes after pancreaticoduodenectomy: A retrospective cohort study

Daniel Negrini; Mayan Ihsan; Karine Freitas; Caroline Pollazzon; Jacqueline Graaf; Jorge Andre; Tatiana Linhares; Virna Brandao; Gustavo Silva; Rossano Fiorelli; Patrick Barone

doi:10.1016/j.sopen.2022.07.004

The clinical impact of the perioperative epidural anesthesia on surgical outcomes after pancreaticoduodenectomy: A retrospective cohort study

Surg Open Sci. 2022 Jul 22:10:91-96. doi: 10.1016/j.sopen.2022.07.004. eCollection 2022 Oct.

Authors

Daniel Negrini^{1

2}, Mayan Ihsan³, Karine Freitas⁴, Caroline Pollazzon², Jacqueline Graaf², Jorge Andre^{2

5}, Tatiana Linhares⁶, Virna Brandao¹, Gustavo Silva¹, Rossano Fiorelli⁷, Patrick Barone⁸

Affiliations

¹ Department of Anesthesiology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, (RJ), Brazil.
² School of Medicine, Serra dos Orgaos University Foundation, Teresopolis, (RJ), Brazil.
³ Department of Anesthesiology, Medical City Teaching Hospitals, Baghdad, Iraq.
⁴ School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, (RJ), Brazil.
⁵ Department of Intensive Care Medicine, National Cancer Institute, Rio de Janeiro, (RJ), Brazil.
⁶ Department of Internal Medicine, Unimed Barra Hospital, Rio de Janeiro, (RJ), Brazil.
⁷ Department of General Surgery, Federal University of the State of Rio de Janeiro, Rio de Janeiro, (RJ), Brazil.
⁸ Department of Anesthesiology, Federal University of Rio Grande do Sul, Porto Alegre, (RS), Brazil.

Abstract

Background: Pancreaticoduodenectomy is a highly invasive procedure associated with high morbidity. Several preoperative variables are associated with postoperative complications. The role of perioperative factors is uncertain. The use of perioperative epidural analgesia is potentially associated with fewer postoperative surgical complications. We hypothesize that perioperative epidural analgesia might be associated with fewer surgical complications.

Methods: We reviewed data from 288 cases performed at our institution between 2012 and 2019, classifying patients into 2 groups: perioperative use of epidural analgesia and non-perioperative use of epidural analgesia. The decision to use epidural as an adjunct to general anesthesia was based on the judgment of the attending anesthesiologist. Uni- and multivariate analyses were then performed to determine factors associated with postoperative surgical complications, ie, postoperative pancreatic fistula, delayed gastric emptying, among others, after adjusting for confounders.

Results: Baseline and intraoperative factors were similar between the groups, except for sex and postoperative surgical complications. In the univariate analyses, factors associated with fewer postoperative surgical complications were the diameter of the pancreatic duct ≥ 6 mm, hard pancreatic gland parenchyma texture, younger age (< 65 years), and perioperative use of epidural analgesia. In the multivariate analyses, perioperative use of epidural analgesia was significantly associated with fewer postoperative surgical complications (odds ratio = 0.31; 95% confidence interval: 0.13-0.75; P = .009), even after adjusting for significant covariates.

Conclusion: Perioperative use of epidural analgesia might be associated with fewer postoperative surgical complications after pancreaticoduodenectomy even after adjusting for pancreatic gland parenchyma texture, pancreatic duct size, and age.