Enhanced Recovery After Surgery (ERAS) Outcomes After Liver and Pancreas Surgery Based on Regional Perioperative Pain Modalities

Introduction: ON-Q pumps, or surgically placed wound catheters, provide analgesia without the side effects of epidural catheters. This study aimed to evaluate perioperative outcomes, including total postoperative oral morphine milligram equivalents (MMEs), perioperative intravenous (IV) fluid volume, and maximum patient-reported pain scale values, in pancreatic or hepatic resection patients on an Enhanced Recovery After Surgery (ERAS) pathway with ON-Q pumps versus other perioperative pain modalities. Methods: Patients undergoing ERAS protocol pancreatic or hepatic resection at our institution from January 2019 to March 2022 were included. Patients were categorized based on ON-Q pump, epidural, or transversus abdominis plane (TAP) block/local anesthetic. Total postoperative oral morphine milligram equivalents (MMEs), perioperative intravenous (IV) fluid volume, and maximum patient-reported pain scale values were analyzed. Results: Of 537 included patients, 249 (46%) received an epidural, 116 (22%) received an ON-Q pump, and 172 (32%) received a TAP block/local anesthetic. ON-Q pump patients required significantly less IV fluids (2,933 mL) compared to 3,379 mL for epidural and 3,278 mL for TAP block/local anesthetic patients (p=0.0037). There was no significant difference in MME requirement or pain scores across pain modalities. Conclusions: ON-Q pump patients had significantly lower IV fluid requirements, though similar pain scores and MME requirements as epidurals or TAP blocks/local anesthetics. The use of ON-Q pumps as a main perioperative pain modality should be considered for ERAS pathway patients.