72198 - Pain management after minimally invasive gastrectomy: do we need epidural analgesia?

Introduction Epidural analgesia has been gold standard for postoperative pain management in gastric cancer surgery. As minimally invasive (MI) techniques have reduced the surgical trauma, the necessity of epidurals is questioned. This study aimed to evaluate if MI gastrectomy without epidural analgesia was associated with shorter hospital stays and fewer complications compared to MI gastrectomy with epidural analgesia. Method Patients undergoing MI gastrectomy for cancer at Karolinska University Hospital (Jan 2015–Aug 2023) were identified. Data were collected prospectively in an institutional database and retrospectively from medical records. Primary outcome was length of hospital stay. Secondary outcomes included postoperative complications, pain scores, need of postoperative norepinephrine and days in higher care units. Result Among 211 patients, 43 (20.4%) had epidurals, and 168 (79.6%) did not, with 12 (7%) of the latter requiring epidurals postoperatively. Epidural patients had lower pain scores (p<0.001) but required median 11.5h longer norepinephrine infusion (p<0.001) and 1 day longer in high dependency care unit (p<0.001). Both overall (55.8% vs 39.9% p=0.060) and severe surgical complications (20.9% vs 9.5% p=0.039) were more common in the epidural group. Median hospital stay was 1 day longer in the epidural group (p<0.001), multivariable adjusted difference was 1.15 days (95% CI: -9.12, -2.37, p=0.034). Discussion MI gastrectomy without epidural analgesia was associated with advantages including shorter hospital stays, fewer postoperative complications, reduced postoperative norepinephrine use, and decreased high dependency care duration. Both groups experienced satisfactory pain relief, demonstrating that MI gastrectomy without epidural analgesia can be associated with improved outcomes.