Effect of patient-controlled epidural analgesia versus patient-controlled intravenous analgesia on postoperative pain management and short-term outcomes after gastric cancer resection: a retrospective analysis of 3,042 consecutive patients between 2010 and 2015

Liping Wang, Xuan Li, Hong Chen, Jie Liang, Yu Wang Department of Anaesthesiology, Harbin Medical University Cancer Hospital, Harbin, China Background: Effective postoperative analgesia is essential for rehabilitation after surgery. Many studies have compared different methods of postoperative pain management for open abdominal surgery. However, the conclusions were inconsistent and controversial. In addition, few studies have focused on gastric cancer (GC) resection. This study aimed to determine the effects of patient-controlled epidural analgesia (PCEA) on postoperative pain management and short-term recovery after GC resection compared with those of patient-controlled intravenous analgesia (PCIA). Methods: We analyzed retrospectively collected data on patients with non-metastatic GC diagnosed between 2010 and 2015 who underwent resection in a university hospital. PCIA and PCEA documented by the acute pain service team were retrospectively analyzed. A propensity score-matched analysis that incorporated preoperative variables was used to compare the short-term outcomes between the PCIA and PCEA groups. Results: In total, 3,042 patients were identified for analysis. Propensity score matching resulted in 917 patients in each group. The PCEA group exhibited lower pain scores in the recovery room and on the first and second postoperative days (P=0.0005, P=0.0065, and P=0.0034 respectively). The time to the first passage of flatus after surgery was shorter in the PCEA group than in the PCIA group (P=0.032). The length of the hospital stay was 12.6±7.2 and 11.8±6.6 days in the PCEA and PCIA groups, respectively. No significant differences were observed in the length of hospital stay or the incidence of complications after surgery. Conclusion: PCEA provided more effective postoperative pain management and a shorter time to the first passage of flatus than PCIA after GC resection. However, it did not have an effect on the length of hospital stay or the incidence of postoperative complications. Keywords: gastrectomy, gastric cancer, patient-controlled analgesia, epidural analgesia, short-term outcomes, pain treatment, analgesia-related complication