Postoperative Pain Treatment After Pancreatic Surgery: A Systematic Review With Meta-Analyses and Trial Sequential Analyses.
Caroline D Lassen, Fatieh Yousef, Eske Kvanner Aasvang et al.
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In 30 seconds
This PROSPERO-registered systematic review and meta-analysis examined postoperative analgesia after total pancreatectomy, pancreaticoduodenectomy, and distal pancreatectomy. It included 18 randomised controlled trials with 1468 patients and conducted 10 meta-analyses. COX inhibitors reduced pain at rest on postoperative day two compared with placebo or no intervention. Pain scores were similar for epidural analgesia and less invasive approaches on days one and two, while paravertebral block or wound infiltration was associated with lower scores on day three. Evidence certainty ranged from very low to low, and no strategy was established as superior.
Key findings
- Across 18 randomised trials, 1468 patients were included and 10 meta-analyses were performed.
- COX inhibitors reduced pain scores at rest on postoperative day two versus placebo or no intervention.
- Epidural and less invasive techniques had similar pain scores on postoperative days one and two; less invasive techniques had lower scores on day three.
- GRADE certainty ranged from very low to low, and evidence did not establish superiority of any analgesic strategy.
Why it matters
Postoperative pain can impede mobilisation and recovery after major pancreatic surgery, making effective analgesia important. The findings suggest that less invasive approaches may achieve pain control comparable to epidural analgesia during the first postoperative days, while evidence for choosing among strategies remains uncertain. This helps frame analgesic options without implying that one approach is definitively best.
What to keep in mind
The meta-analyses were small, and the certainty of evidence ranged from very low to low.