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Background: Although laparoscopic approaches are generally considered to result in reduced postoperative pain compared to open approaches, objective evaluation of amount of opioid consumption has not been evaluated for pancreaticoduodenectomy.
Aim: The aim of this study was to investigate if total laparoscopic pancreaticoduodenectomy (TLPD) results in reduced opioid consumption over open pancreaticoduodenectomy (OPD).
Methods: A single-institutional retrospective cohort study of all patients having undergone pancreaticoduodenectomy between 2007 and 2010 was performed. Postoperative pain was evaluated by calculating opioid consumption from postoperative day (POD) 1 to POD 5. Five forms of narcotic analgesics were used including: morphine, hydromorphine, oxicodone, hydrocodone and fentanyl. To allow comparison, narcotic consumption was converted to morphine equivalents using a standard conversion. Daily and total opioid consumption after PD was compared between the LPD and (OPD) groups. Risk factors for increased total opioid consumption were evaluated using univariate and multivariate analyses.
Results: Five hundred and twelve consecutive patients (LPD n = 123, OPD n = 390) were included in this study. Six patients (5%) with conversion to OPD were included in LPD group based on intent-to-treat. Daily opioid consumption of the LPD group was significantly less than that of OPD group from POD 2 through POD 5, and total opioid consumption of LPD group was also significantly less (LPD: 5.3 ± 6.4 mg/kg, OPD: 7.3 ± 9.4 mg/kg, P = 0.007). Multivariate analysis revealed that younger age (< 65 years old) (HR 1.89, 95% CI 1.29 - 2.79, P = 0.001), no preoperative diabetes mellitus (HR 1.74, 95% CI 1.10 - 2.80, P = 0.01), PD for chronic pancreatitis (HR 2.87, 95% CI 1.18 - 7.51, P = 0.02), OPD (HR 2.01, 95% CI 1.26 - 3.27, P = 0.003) and postoperative major complication (Grade III-V) (HR 2.30, 95% CI 1.36 - 3.91, P = 0.001) were independently associated with increased opioid consumption after PD (total opioid consumption > 6mg/kg).
Conclusion: Patients undergoing TLPD have lless opioid consumption compared to those with the open approach. Younger age, absence of diabetes, chronic pancreatitis indication and major postoperative complications are independent predictors of increased opioid consumption. These findings warrant further evaluation as to the potential clinical impact of reduced pain and less opioid consumption on patient-specific advantages including early recovery and better quality of life after pancreaticoduodenectomy.