Paravertebral versus EPidural Analgesia in Minimally Invasive Esophageal ResectioN (PEPMEN): A Randomized Controlled Multicenter Trial.

Autor:	Feenstra ML; Department of Surgery, Amsterdam UMC location University of Amsterdam, AGEM, Cancer Center Amsterdam, Amsterdam, the Netherlands.; Department of Anesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands., Kooij CD; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands., Eshuis WJ; Department of Surgery, Amsterdam UMC location University of Amsterdam, AGEM, Cancer Center Amsterdam, Amsterdam, the Netherlands., de Groot EM; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands., Hermanides J; Department of Anesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands., Kingma BF; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands., Gisbertz SS; Department of Surgery, Amsterdam UMC location University of Amsterdam, AGEM, Cancer Center Amsterdam, Amsterdam, the Netherlands., Ruurda JP; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands., Daams F; Department of Surgery, Amsterdam UMC location University of Amsterdam, AGEM, Cancer Center Amsterdam, Amsterdam, the Netherlands., Marsman M; Department of Anesthesiology, University Medical Center Utrecht, Utrecht, the Netherlands., van den Bosch OFC; Department of Anesthesiology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Ten Hoope W; Department of Anesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands., Goense L; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands., Luyer MDP; Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands., Nieuwenhuijzen GAP; Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands., Scholten HJ; Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands., Buise M; Department of Anesthesia and Pain medicine, Maastricht University Medical Center, Maastricht, The Netherlands., van Det MJ; Department of Surgery, Hospital Group Twente, Almelo, The Netherlands., Kouwenhoven EA; Department of Surgery, Hospital Group Twente, Almelo, The Netherlands., van der Meer F; Department of Anesthesiology, Hospital Group Twente, Almelo, The Netherlands., Frederix GWJ; Department of Public Health, Healthcare Innovation & Evaluation and Medical Humanities, University Medical Center Utrecht, Utrecht, the Netherlands., Hollmann MW; Department of Anesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands., Cheong E; Department of Upper GI, PanAsia Surgery, Singapore., van Berge Henegouwen MI; Department of Surgery, Amsterdam UMC location University of Amsterdam, AGEM, Cancer Center Amsterdam, Amsterdam, the Netherlands., van Hillegersberg R; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2024 Oct 03. Date of Electronic Publication: 2024 Oct 03.
DOI:	10.1097/SLA.0000000000006551
Abstrakt:	Objective: To compare quality of recovery in patients receiving epidural or paravertebral analgesia for minimally invasive esophagectomy (MIE). Summary Background Data: Paravertebral analgesia may be a promising alternative to epidural analgesia, avoiding potential side effects and improving postoperative recovery. Methods: This randomized controlled superiority trial was conducted across four Dutch centers with esophageal cancer patients scheduled for transthoracic MIE with intrathoracic anastomosis, randomizing patients to receive either epidural or paravertebral analgesia. The primary outcome was Quality of Recovery (QoR-40) on the third postoperative day (POD). Secondary outcomes included quality of life, postoperative pain, opioid consumption, inotropic/vasopressor medication use, hospital stay, complications, readmission, and mortality. Results: From December 2019 to February 2023, 192 patients were included: 94 received epidural and 98 paravertebral analgesia. QoR-40 score on POD3 was not different between groups (mean difference 3.7, 95%CI -2.3 to 9.7; P=0.268). Epidural patients had significant higher QoR-40 scores on POD1 and 2 (mean difference 7.7, 95%CI 2.3-13.1; P=0.018 and mean difference 7.3, 95%CI 1.9-12.7; P=0.020) and lower pain scores (median 1 versus 2; P=<0.001 and median 1 versus 2; P=0.033). More epidural patients required vasopressor medication on POD1 (38.3% versus 13.3%; P<0.001). Urinary catheters were removed earlier in the paravertebral group (median POD3 versus 4; P=<0.001). No significant differences were found in postoperative complications or hospital/Intensive Care Unit stay. Conclusions: This randomized controlled trial did not demonstrate superiority of paravertebral over epidural analgesia regarding quality of recovery on POD3 after MIE. Both techniques are effective and can be offered in clinical practice. Competing Interests: Declaration of interests Prof. dr. Ruurda reported serving an advisory or consulting role for Intuitive Surgical and Medtronic. Prof. dr. Luyer reported receiving research grants from Medtronic outside the submitted work. Dr. Nieuwenhuijzen reported serving a consulting or advisory role for Medtronic. Dr. Buise reported serving a consulting or advisory role for Medtronic. Dr. van Det reported serving a consulting or advisory role for Intuitive Surgical. Dr. Kouwenhoven reported serving a consulting or advisory role for Intuitive Surgical. Prof. dr. Hollmann reported serving roles as Executive Section Editor Pharmacology with Anesthesia & Analgesia, Section Editor Anesthesiology with J Clin Med, Editor with Front Physiol, and research support and honorarium for consultancy by PAION, Medical Developments & IDD Pharma. Prof. dr. van Berge Henegouwen reported serving a consulting or advisory roles for Viatris, Johnson & Johnson, BBraun, Stryker and Medtronic, all fees paid to the institution. Prof. dr. van Hillegersberg reported serving a consulting or advisory role for Intuitive Surgical, Medtronic and Olympus. The other authors have no conflicts of interest to declare. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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