ASO Author Reflections: How Can We Improve the Postoperative Experience for Our Pancreatic Cancer Patients? A Practical Technique to Optimize Pain Control After Major Abdominal Surgery

Excerpt

Pain control after major hepatopancreaticobiliary (HPB) surgery traditionally employs opioid analgesia. Whether by intermittent injections or patient-controlled analgesia (PCA), short-acting opioids have been the mainstay of treatment. This approach is known to result in excess opioid consumption, potential narcotic dependence, respiratory depression, nausea, emesis, drowsiness, and delayed return of bowel function.1 As postoperative ileus and delayed gastric emptying are the main drivers of length of stay after pancreatic surgery, efforts to minimize opioid use and increase early ambulation have been at the forefront of enhanced recovery after surgery (ERAS) pathways. Epidural anesthesia is an important and popular pain control strategy that, when functioning well, can decrease narcotic use and improve pain control. Unfortunately, there remains conflicting and confusing data on the benefit of epidural analgesia after HPB surgery. The most recent ERAS Society guidelines reported a weak recommendation for the use of epidurals after pancreatic surgery2 and a strong recommendation against the use of epidural anesthesia in hepatic surgery.3 Thus, there is clearly a gap in knowledge of how to best provide adequate pain control after pancreatic surgery while minimizing opioids, particularly for cancer patients. …