Retrospective observational study of patient outcomes with local wound infusion vs epidural analgesia after open hepato-pancreato-biliary surgery

Background Epidural analgesia is conventionally used as the mainstay of analgesia in open abdominal surgery but has a small life-changing risk of complications (epidural abscesses or haematomas). Local wound-infusion could be a viable alternative and are associated with fewer adverse effects. Methods A retrospective observational analysis of individuals undergoing open hepato-pancreato-biliary surgery over 1 year was undertaken. Patients either received epidural analgesia (EP) or continuous wound infusion (WI) + IV patient controlled anaesthesisa (PCA) with an intraoperative spinal opiate. Outcomes analyzed included length of stay, commencement of oral diet and opioid use. Results Between Jan 2016- Dec 2016, 110 patients were analyzed (WI n=35 , EP n=75 ). The median length of stay (days) was 8 in both the WI and EP group ( p=0.846 ), the median time to commencing oral diet (days) was 3 in WI group and 2 in EP group ( p=0.455 ). There was no significant difference in the amount of oromorph, codeine or tramadol (mg) between WI and EP groups ( p = 0.829 , p=0.531, p=0.073, respectively). Conclusions Continuous wound infusion + IV PCA provided adequate analgesia to patients undergoing open hepato-pancreato-biliary surgery. It was non-inferior to epidural analgesia with respect to hospital stay, commencement of oral diet and opioid use.