title: For patients undergoing pancreatoduodenectomy, epidural anesthesia and analgesia improves pain but increases rates of intensive care unit admissions and alterations in analgesics.
abstract: OBJECTIVE
  For some procedures, epidural anesthesia and analgesia (EAA) improves clinical outcomes. It is used during pancreatoduodenectomy (PD) to mitigate morbidities and shorten hospitalizations. Although widespread, the use of this practice has not been examined extensively. The objective of this study was to do so.
  
  
  METHODS
  A retrospective review of 42 patients who underwent PD was performed. Patients with and without EAA were compared. End points included intraoperative blood losses, perioperative fluid requirements, intensive care unit admissions, pain, bowel function, lengths of stay, morbidities, and mortalities.
  
  
  RESULTS
  Eighteen patients received EAA; 24 did not. Patients with EAA who reported less pain on postoperative day 2 (P = 0.03) were more likely to require intensive care unit admissions (P = 0.02) and required more frequent alterations of analgesics (P = 0.0001001). Epidural anesthesia and analgesia was associated with a nonsignificant increase in blood losses and fluid requirements. The groups did not differ in bowel function, lengths of stay, morbidities, or mortalities.
  
  
  CONCLUSIONS
  For patients undergoing PD, EAA was not associated with clinical benefits except for a modest reduction in postoperative pain, which was limited to a single day. Therefore, in this study, the clinical benefits of EAA seem underwhelming.
authors: Division of Surgical Oncology, Department of Surgery, University of Rochester, Rochester, NY 14642, USA.
authors: Daniel X
authors: DX
authors: Choi
authors: Luke O
authors: LO
authors: Schoeniger
mesh_terms: D000368:Aged; D000698:Analgesia / Q000379:methods*; D015360:Analgesia, Epidural / Q000379:methods*; D000700:Analgesics / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D010343:Patient Admission / Q000706:statistics & numerical data*; D012189:Retrospective Studies
chemical_list: D000700:Analgesics