Thoracic epidural analgesia (TEA) is associated with greater pain control, lower need for narcotics, and fewer complications after hepatopancreatobiliary (HPB) surgery compared with intravenous patient-controlled analgesia (IV-PCA), according to results of a randomized controlled trial published in the Annals of Surgery.1

Investigators randomly assigned 140 patients to receive TEA (n=106) or IV-PCA (n=34) and compared outcomes in the first 48 hours following HPB surgery.

The 2 groups were similar in terms of baseline comorbidities, demographics, and clinical or operative variables. The Likert 0 to 10 scale was used to assess pain scores..

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Freedom from pain scores following HPB surgery was significantly higher in the TEA vs the IV-PCA group (37.11 ± 24.64 vs 25.93 ± 16.74; P =.010 for both). No significant difference in anesthesia-related adverse events was observed between the TEA and IV-PCA groups (12.2% and 2.9%, respectively; P =.187). Patients receiving TEA also experienced a lower need for daily narcotics for most of postoperative days 0 to 3 (P <.001 for all).

The investigators of this study commented that the reduced need for narcotics in this patient population is an important finding, considering that “the United States grapples with a significant narcotic dependence that is frequently initiated during a procedure or surgery.”

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  1. Aloia TA, Kim BJ, Segraves-Chun YS, et al. A randomized controlled trial of postoperative thoracic epidural analgesia versus intravenous patient-controlled analgesia after major hepatopancreatobiliary surgery. Ann Surg. 2017;266:545-554.