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Introduction: While multiple studies report favorable outcomes with epidural anesthesia and analgesia (EAA) use during major abdominal surgery, there is limited data in regards to EAA use during pancreatic head resection. A recent switch from EAA to narcotic PCA with OnQ pain catheters, allowed us to critically evaluate outcomes in patients undergoing a Whipple procedure with and without an epidural catheter.
Methods: After obtaining IRB approval, a retrospective chart review of 100 pancreaticoduodenectomies (PD) was performed; this included our most recent 50 patients without EAA use, and the last 50 patients with EAA just before we discontinued using this device, with all cases spanning from March of 2008 to July of 2011. Peri-operative and immediate post-operative clinical outcomes were compared.
Results: For obvious reasons, but not without importance, EAA patients had longer time from anesthesia start time to surgery start time (p=0.004). The EAA group had significantly higher rates of intra-operative hypotension (p= 0.001), and revealed a trend towards a higher intra-operative blood transfusion rate (56% EAA vs. 38%, p=0.071). No statistical significance was found between groups in terms of length of surgery, estimated blood loss, or intra-operative fluid administration. Post-operatively, EAA patients had a significant delay in diet initiation (8 days vs 5.6 days, p=0.015), and a higher requirement of post-operative fluid administration on post-op day # 1 (3,983 ml VS. 3,088.1 ml, p=0.001). Although the overall morbidity rate was similar between the two groups, the EAA group had higher rates of urinary tract infections (5/50 VS. 1/50), and intra-abdominal abscess (5/50 VS. 0/50). 10 of 50 (20%) patients in the EAA group had premature discontinuation of epidural catheter secondary to hypotension or inadequate pain control. Length of stay was similar between the two groups (EAA- 17 days VS. PCA- 15.1 days, p>0.05).
Conclusions: In the current study, EAA during PD was associated with a delay in surgery start time, increased episodes of intra-operative hypotension, a trend toward increased intra-operative blood transfusion and a 20% device failure rate. While pain relief may be excellent with EAA, these issues must be considered when selecting a peri-operative pain control strategy.