Analgesic patterns and predictors of opioid consumption following epidural analgesia discontinuation after pancreatic cancer surgery.

Abstract

Introduction: Thoracic epidural analgesia (EDA) is recommended for multimodal perioperative pain management. However, increased pain and opioid consumption are frequently observed following EDA discontinuation. Risk factors for this transition phase remain poorly characterized after pancreatic surgery.

Aim: The primary aim was to characterize analgesic strategies, including opioid consumption and use of non-opioid agents, following EDA discontinuation after pancreatic cancer surgery (days 0-2). The secondary aim was to determine predictors of increased opioid consumption on the day of EDA discontinuation (day 0).

Methods: In this retrospective cohort study, adult patients who underwent pancreatic cancer surgery between 01 June 2021 and 31 June 2023 at Sahlgrenska University Hospital, Gothenburg, Sweden, and received postoperative EDA were identified using institutional electronic health records. Total daily opioid consumption (oral morphine equivalent daily dose, OMEDD) and non-opioid pharmacological treatments were characterized. Factors associated with opioid consumption on day 0 were determined using multivariable linear regression. Variable importance analysis based on R² decomposition (Lindeman-Merenda-Gold method) was performed.

Results: A total of 194 patients were included. Median OMEDD (IQR) was 98 (60-142) mg on day 0, 75 (60-105) mg on day 1, and 60 (45-90) mg on day 2. EDA duration, age, epidural infusion rates, and preoperative opioid use were independently associated with opioid consumption at EDA discontinuation. Preoperatively confirmed malignancy and EDA analgesic failure showed potential associations. The final model explained 20.8 % of the variance in opioid consumption (adjusted R²=0.208).

Conclusions: The transition from EDA to oral analgesia after pancreatic surgery is accompanied by high opioid consumption. In this cohort, longer EDA treatment, younger age, higher epidural infusion rates, and preoperative opioid use were associated with increased opioid consumption at EDA discontinuation, suggesting that patients at risk of high opioid usage may be identified in advance and could benefit from tailored, multimodal opioid-sparing strategies.