Efficacy and safety of nefopam versus epidural analgesia for perioperative pain management in pancreaticoduodenectomy: a prospective randomized study

The problem of perioperative analgesia for extensive abdominal surgeries remains relevant, as available experience of widespread epidural analgesia revealed limitations and complexities of this approach. Objective. To compare the efficacy and safety of perioperative thoracic epidural analgesia and nefopam therapy (opioid-sparing strategy), and to analyze the impact of analgesia methods on postoperative complications. Material and methods. The study included 60 patients with biliopancreatoduodenal tumors who underwent (gastro)pancreatoduodenectomy (G(PDD)). Patients were randomized into 2 groups: the nefopam group (N, n=30) and the epidural analgesia group (EA, n=30). We assessed course of anesthesia, NRS scores of postoperative pain syndrome at rest and during mobilization, serum glucose and cortisol at different stages of follow-up, opioid requirements, onset of peristalsis and first defecation, postoperative complications. Results. Pain syndrome was less severe in the group N on days 1 and 2 after surgery (p=0.012 and p=0.045). After 2 and 3 days, the need for morphine was significantly lower in group N, where mean dose was 14.42 (95% CI 12.30—16.54) mg/day and 8.60 (95% CI 6.05—11.15) mg/day. In the group EA, these values were 19.33 (95% CI 15.41—23.26) mg/day and 13.92 (95% CI 10.58—17.26) mg/day, respectively (p=0.029 and p=0.012). Independent predictors of pancreatic fistula were high BMI, intraoperative blood loss and postoperative infusion volume. Conclusion. Both techniques allow for adequate pain control after pancreaticoduodenectomy. Nefopam has higher opioid-sparing effect in postoperative period. The impact of perioperative analgesia technique on postoperative complications after pancreaticoduodenectomy requires further investigation.