Different titration protocols in pain management after radical gastrectomy for gastric cancer patients.

Abstract

Background: Effective pain management after radical gastrectomy is crucial for patient recovery. With the promotion of enhanced recovery after surgery protocols, postoperative pain management has become a core component of perioperative care. However, controversy remains regarding the optimal frequency of analgesic titration for pain control.

Aim: To compare the efficacy of 12-hour vs 24-hour titration regimens in postoperative pain management following radical gastrectomy for gastric cancer.

Methods: This retrospective comparative study analyzed data from 120 patients who underwent radical gastrectomy between January 2021 and December 2022, with 52 patients receiving a 12-hour titration regimen and 68 patients receiving a 24-hour titration regimen. All patients received patient-controlled intravenous analgesia containing sufentanil and tropisetron postoperatively with identical initial settings.

Results: The 12-hour titration group demonstrated significantly lower pain scores at 12 hours postoperatively compared to the 24-hour group (3.2 vs 4.8, P < 0.001); total analgesic consumption (morphine equivalents) was reduced by 28.6% (30 mg vs 42 mg, P < 0.001); postoperative nausea and vomiting decreased by 50% (15% vs 30%, P = 0.02); respiratory depression was less frequent (2% vs 8%, P = 0.04); patient satisfaction was higher (85% vs 65% reporting "very satisfied" or "satisfied", P < 0.001); and hospital stay was shortened by 12.5% (4.2 days vs 4.8 days, P = 0.02). Cox regression analysis showed that the 12-hour regimen was associated with a lower risk of prolonged high-intensity pain (hazard ratio = 0.65, 95% confidence interval: 0.45-0.93, P = 0.02), and multivariate regression analysis confirmed that the 12-hour regimen was an independent predictor of better overall recovery (β = -0.32, P = 0.01).

Conclusion: Compared to the 24-hour titration regimen, the 12-hour titration regimen provided more effective control of early postoperative pain after radical gastrectomy, reduced total analgesic consumption, lowered the incidence of related adverse reactions, improved patient satisfaction, and shortened hospital stays.