Pain and Opioid Consumption After Laparoscopic Versus Open Gastrectomy for Gastric Cancer: A Secondary Analysis of a Multicenter Randomized Clinical Trial (LOGICA-Trial)

Background Laparoscopic gastrectomy could reduce pain and opioid consumption, compared to open gastrectomy. However, it is difficult to judge the clinical relevance of this reduction, since these outcomes are reported in few randomized trials and in limited detail. Methods This secondary analysis of...

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Published in:Journal of gastrointestinal surgery 2023-10, Vol.27 (10), p.2057-2067
Main Authors: van der Veen, Arjen, Ramaekers, Mark, Marsman, Marije, Brenkman, Hylke J. F., Seesing, Maarten F. J., Luyer, Misha D. P., Nieuwenhuijzen, Grard A. P., Stoot, Jan H. M. B., Tegels, Juul J. W., Wijnhoven, Bas P. L., de Steur, Wobbe O., Kouwenhoven, Ewout A., Wassenaar, Eelco B., Draaisma, Werner A., Gisbertz, Suzanne S., van der Peet, Donald L., May, Anne M., Ruurda, Jelle P., van Hillegersberg, Richard
Format: Article
Language:English
Subjects:
Analgesics, Opioid - therapeutic use
Epidural
Gastrectomy - adverse effects
Gastric cancer
Gastroenterology
Gastrointestinal surgery
Humans
Laparoscopy
Medicine
Medicine & Public Health
Narcotics
Original
Original Article
Pain
Pain, Postoperative - drug therapy
Pain, Postoperative - etiology
Stomach Neoplasms - drug therapy
Stomach Neoplasms - surgery
Surgery
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Summary:Background Laparoscopic gastrectomy could reduce pain and opioid consumption, compared to open gastrectomy. However, it is difficult to judge the clinical relevance of this reduction, since these outcomes are reported in few randomized trials and in limited detail. Methods This secondary analysis of a multicenter randomized trial compared laparoscopic versus open gastrectomy for resectable gastric adenocarcinoma (cT1-4aN0-3bM0). Postoperative pain was analyzed by opioid consumption in oral morphine equivalents (OME, mg/day) at postoperative day (POD) 1–5, WHO analgesic steps, and Numeric Rating Scales (NRS, 0–10) at POD 1–10 and discharge. Regression and mixed model analyses were performed, with and without correction for epidural analgesia. Results Between 2015 and 2018, 115 patients in the laparoscopic group and 110 in the open group underwent surgery. Some 16 patients (14%) in the laparoscopic group and 73 patients (66%) in the open group received epidural analgesia. At POD 1–3, mean opioid consumption was 131, 118, and 53 mg OME lower in the laparoscopic group, compared to the open group, respectively (all p  
ISSN:1091-255X
1873-4626
DOI:10.1007/s11605-023-05728-3