title: Peri-operative epidural may not be the preferred form of analgesia in select patients undergoing pancreaticoduodenectomy.
abstract: OBJECTIVE
  Epidural analgesia has become the preferred method of pain management for major abdominal surgery. However, the superior form of analgesia for pancreaticoduodenecomy (PD), with regard to non-analgesic outcomes, has been debated. In this study, we compare outcomes of epidural and intravenous analgesia for PD and identify pre-operative factors leading to early epidural discontinuation.
  
  
  METHODS
  A retrospective review was performed on 163 patients undergoing PD between 2007 and 2011. We performed regression analyses to measure the predictive success of two groups of analgesia on morbidity and mortality and to identify predictors of epidural failure.
  
  
  RESULTS
  Intravenous analgesia alone was given to 14 (9%) patients and 149 patients (91%) received epidural analgesia alone or in conjunction with intravenous analgesia. Morbidity and mortality were not significantly different between the two groups. Early epidural discontinuation was necessary in 22 patients (15%). Those older than 72 and with a BMI < 20 (n = 5) had their epidural discontinued in 80% of cases compared to 12% not meeting these criteria. However, early epidural discontinuation was not associated with increased morbidity and mortality.
  
  
  CONCLUSIONS
  Epidural analgesia may be contraindicated in elderly, underweight patients undergoing PD given their increased risk of epidural-induced hypotension or malfunction.
authors.affiliation: Department of Surgery, Loyola University Chicago, Health Sciences Campus, Stritch School of Medicine, Maywood, Illinois.
authors.forename: Trevor M
authors.initials: TM
authors.lastname: Axelrod
authors.forename: Bernardino M
authors.initials: BM
authors.lastname: Mendez
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Abood
authors.forename: James M
authors.initials: JM
authors.lastname: Sinacore
authors.forename: Gerard V
authors.initials: GV
authors.lastname: Aranha
authors.forename: Margo
authors.initials: M
authors.lastname: Shoup
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007022:Hypotension / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000401:mortality / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate
keywords: complications, elderly; whipple