Comparison of epidural anesthesia and intravenous self-control analgesia on postoperative recovery quality in duodenectomy

Table 1 Baseline characteristics of patients after propensity score matching, n (%)¹

Characteristic	EA group (n = 84)	IVPCA group (n = 84)	P value
Age (years)	63.7 ± 8.2	64.3 ± 7.9	0.62
Gender
Male	48 (57.1)	46 (54.8)	0.76
Female	36 (42.9)	38 (45.2)	0.76
BMI (kg/m2)	24.3 ± 3.1	24.6 ± 3.3	0.55
ASA physical status			0.91
I	12 (14.3)	10 (11.9)
II	54 (64.3)	56 (66.7)
III	18 (21.4)	18 (21.4)
Comorbidities
Diabetes mellitus	24 (28.6)	26 (31.0)	0.73
Hypertension	35 (41.7)	33 (39.3)	0.76
Coronary artery disease	15 (17.9)	17 (20.2)	0.69
COPD	9 (10.7)	11 (13.1)	0.64
Indication for surgery			0.64
Pancreatic cancer	49 (58.3)	52 (61.9)
Periampullary cancer	21 (25.0)	19 (22.6)
Distal bile duct cancer	9 (10.7)	8 (9.5)
Other	5 (6.0)	5 (6.0)
Surgical approach			0.58
Open	78 (92.9)	76 (90.5)
Minimally invasive	6 (7.1)	8 (9.5)
Preoperative laboratory values
Hemoglobin (g/dL)	12.3 ± 1.8	12.1 ± 1.7	0.45
Albumin (g/dL)	3.8 ± 0.5	3.7 ± 0.6	0.22
Total bilirubin (mg/dL)	2.1 ± 3.4	2.3 ± 3.6	0.70

¹Data are presented as mean ± SD for continuous variables and n (%) for categorical variables.

EA: Epidural anesthesia; IVPCA: Intravenous patient-controlled analgesia; BMI: Body mass index; ASA: American Society of Anesthesiologists; COPD: Chronic obstructive pulmonary disease.

Table 2 Comparison of pain control and related outcomes between groups, n (%)

Outcome	EA Group (n = 84)	IVPCA Group (n = 84)	P value
Pain scores (VAS 0-10)
At rest
12 hours	2.1 ± 0.8	4.3 ± 1.1	< 0.001
24 hours	2.4 ± 0.9	4.7 ± 1.2	< 0.001
48 hours	1.9 ± 0.7	3.8 ± 1.0	< 0.001
72 hours	1.6 ± 0.6	3.2 ± 0.9	< 0.001
During movement
12 hours	4.2 ± 1.3	6.5 ± 1.5	< 0.001
24 hours	3.8 ± 1.1	6.3 ± 1.4	< 0.001
48 hours	3.3 ± 1.0	5.4 ± 1.3	< 0.001
72 hours	2.7 ± 0.9	4.6 ± 1.2	< 0.001
Analgesic consumption
Total opioid consumption (morphine equivalent, mg)	32.6 ± 8.4	68.5 ± 14.7	< 0.001
Rescue analgesic requirements	14 (16.7)	37 (44.0)	< 0.001
Analgesia-related adverse effects
Nausea and vomiting	16 (19.0)	27 (32.1)	0.048
Pruritus	6 (7.1)	14 (16.7)	0.031
Hypotension	14 (16.7)	6 (7.1)	0.031
Respiratory depression	2 (2.4)	5 (6.0)	0.246
Urinary retention	9 (10.7)	7 (8.3)	0.601
Patient satisfaction with pain management (0-10)	8.3 ± 1.2	7.1 ± 1.5

EA: Epidural anesthesia; IVPCA: Intravenous patient-controlled analgesia; VAS: Visual Analog Scale.

Table 3 Comparison of gastrointestinal recovery outcomes between groups, n (%)

Indicator	Outcome EA group (n = 84)	IVPCA group (n = 84)	P value
Time to recovery (hours)
First flatus	65.3 ± 12.6	78.9 ± 15.4	< 0.001
First bowel movement	87.2 ± 16.3	103.5 ± 19.8	< 0.001
Toleration of a liquid diet	56.4 ± 11.8	69.7 ± 14.2	< 0.001
Advancement to a regular diet	112.6 ± 20.4	136.8 ± 24.5	< 0.001
Gastrointestinal complications
Postoperative ileus	10 (11.9)	20 (23.8)	0.042
Delayed gastric emptying	14 (16.7)	24 (28.6)	0.031
Nausea and vomiting	16 (19.0)	27 (32.1)	0.048
Nutritional parameters
Duration of total parenteral nutrition (days)	4.1 ± 1.6	5.8 ± 2.3	< 0.001
Weight loss at POD 7 (kg)	2.6 ± 1.1	3.4 ± 1.3	0.008

EA: Epidural anesthesia; IVPCA: Intravenous patient-controlled analgesia; POD: Postoperative day.

Table 4 Comparison of pulmonary complications and respiratory parameters between epidural anesthesia and intravenous patient-controlled analgesia groups, n (%)

Indicator	Parameter EA group (n = 84)	IVPCA group (n = 84)	P value
Pulmonary complications
Overall incidence	10 (11.9)	20 (23.8)	0.042
Atelectasis	7 (8.3)	15 (17.9)	0.038
Pneumonia	3 (3.6)	8 (9.5)	0.047
Respiratory parameters
Oxygen saturation	97.2 ± 1.3	95.8 ± 1.7	0.014
PaO2/FiO2 ratio	342 ± 44	315 ± 52	0.009
Incentive spirometry volume on POD 2 (mL)	1450 ± 320	1210 ± 290	0.007
Oxygen therapy
Duration of supplemental oxygen (hours)	22 (18-36)	36 (24-48)	0.011

EA: Epidural anesthesia; IVPCA: Intravenous patient-controlled analgesia; POD: Postoperative day.

Table 5 Comparison of stress response and metabolic parameters epidural anesthesia and intravenous patient-controlled analgesia groups, n (%)

Indicator	Parameter EA group (n = 84)	IVPCA group (n = 84)	P value
Stress hormones (24 hours postoperative)
Plasma cortisol (nmol/L)	382 ± 87	516 ± 104	< 0.001
Epinephrine (pg/mL)	58 ± 14	93 ± 22	< 0.001
Norepinephrine (pg/mL)	312 ± 74	437 ± 95	< 0.001
Glycemic control
Mean blood glucose (mmol/L)	7.2 ± 0.9	8.6 ± 1.3	< 0.001
Hyperglycemic episodes requiring insulin	20 (23.8)	35 (41.7)	0.013
Inflammatory markers
C-reactive protein at 48 hours (mg/L)	87.3 ± 18.4	113.6 ± 24.7	< 0.001

EA: Epidural anesthesia; IVPCA: Intravenous patient-controlled analgesia.