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

• Published in: Journal of gastrointestinal surgery Vol. 27; no. 10; pp. 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: Journal Article
• Language: English
• Published: New York Springer US 01.10.2023; Springer Nature B.V
• 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; Pain; Opioid consumption; Surgery; Laparoscopic gastrectomy; Randomized trial; Gastrectomy; Gastric cancer
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-023-05728-3

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  < 0.001). After correcting for epidural analgesia, these differences remained significant at POD 1–2 (47 mg OME, p  = 0.002 and 69 mg OME, p  < 0.001, respectively). At discharge, 27% of patients in the laparoscopic group and 43% patients in the open group used oral opioids ( p  = 0.006). Mean highest daily pain scores were between 2 and 4 at all PODs, < 2 at discharge, and did not relevantly differ between treatment arms. Conclusion In this multicenter randomized trial, postoperative pain was comparable between laparoscopic and open gastrectomy. After laparoscopic gastrectomy, this was generally achieved without epidural analgesia and with fewer opioids. Trial Registration NCT02248519.