Continuous wound infiltration versus epidural analgesia after hepato-pancreato-biliary surgery (POP-UP): a randomised controlled, open-label, non-inferiority trial

Continuous wound infiltration versus epidural analgesia after hepato-pancreato-biliary surgery (POP-UP): a randomised controlled, open-label, non-inferiority trial

Mungroop TH, Veelo DP, Busch OR, van Dieren S, van Gulik TM, Karsten TM, de Castro SM, Godfried MB, Thiel B, Hollmann MW, Lirk P, Besselink MG. Lancet Gastroenterol Hepatol. 2016 Oct;1(2):105-113

What is already known:

Epidural analgesia has always been considered the “gold-standard” but slowly that is being questioned. Also the majority of studies with pain as their main outcome, use simple visual analogue scores (VAS)to differentiate the modalities. Importantly however, this is one of the first to include patient reported outcomes as well as VAS.

What this paper adds:

The authors used a validated scoring system called the OBAS score (Overall Benefit of Analgesia Score). It is a validated composite score including analgesia side-effects and patient satisfaction, as well as VAS scores.

They compared epidural analgesia with continuous infusions of local anaesthetic via a wound catheter in patients undergoing various different types of open hepato-pancreato-biliary surgery (mostly pancreatoduodenectomy (35% followed by liver resection (18%)). The authors set out to show that it the wound catheter was not inferior to epidural which they duly did. Vasopressor use was much lower in the wound catheter group. Adding to the growing body of evidence that an epidural is not the only option for major open abdominal surgery.

Chris Jones, Guildford. @chrisnjones