Multimodal analgesia with continuous nerve blocks versus intravenous patient-controlled analgesia for pancreatectomy: a retrospective cohort study.

Abstract

Background: Postoperative pain management after pancreatectomy is challenging due to extensive tissue trauma and visceral pain. Multimodal analgesia (MMA) with continuous peripheral nerve blocks may optimize pain control while reducing opioid consumption. In this study, we aimed to evaluate the efficacy of MMA with continuous peripheral nerve blocks compared with intravenous patient-controlled analgesia (IV PCA).

Methods: This single-center retrospective cohort study compared patients who underwent open pancreatectomy (pancreaticoduodenectomy or distal pancreatectomy) between March 2021 and April 2024 using either MMA with continuous peripheral nerve blocks or IV PCA. Our primary outcome was pain scores through postoperative three days. The secondary outcomes included cumulative morphine consumption, time to first mobilization, morbidity and mortality rates, length of hospital stay, and adverse events. We adjusted for confounders using univariable and multivariable regression analyses and applied generalized estimating equations.

Results: The study included 104 patients; 42 and 62 patients in the MMA and PCA groups, respectively. Patients in the MMA group had significantly lower pain scores on postoperative day 1 (P = 0.002), lower morphine consumption within 72 hours postoperatively (P < 0.001), earlier mobilization, and fewer 14-day readmissions compared to the PCA group. No significant differences were observed in morbidity, mortality, unexpected intensive care unit admission, or length of hospital stay between the groups. Patients who received MMA experienced less nausea and vomiting than those who received PCA, and no serious adverse events occurred in either group.

Conclusions: MMA with continuous peripheral nerve blocks provides effective analgesia, reduces opioid consumption, and facilitates early mobilization compared to IV PCA in pancreatectomy patients. Further randomized controlled trials are required to confirm these findings.