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Randomized Controlled Trial
. 2023 Oct;27(10):2057-2067.
doi: 10.1007/s11605-023-05728-3. Epub 2023 Jul 18.

Pain and Opioid Consumption After Laparoscopic Versus Open Gastrectomy for Gastric Cancer: A Secondary Analysis of a Multicenter Randomized Clinical Trial (LOGICA-Trial)

Arjen van der Veen  1 , Mark Ramaekers  2 , Marije Marsman  3 , Hylke J F Brenkman  4 , Maarten F J Seesing  4 , Misha D P Luyer  2 , Grard A P Nieuwenhuijzen  2 , Jan H M B Stoot  5 , Juul J W Tegels  5 , Bas P L Wijnhoven  6 , Wobbe O de Steur  7 , Ewout A Kouwenhoven  8 , Eelco B Wassenaar  9 , Werner A Draaisma  10 , Suzanne S Gisbertz  11 , Donald L van der Peet  12 , Anne M May  13 , Jelle P Ruurda  4 , Richard van Hillegersberg  14 ; LOGICA study group
Collaborators, Affiliations
Randomized Controlled Trial

Pain and Opioid Consumption After Laparoscopic Versus Open Gastrectomy for Gastric Cancer: A Secondary Analysis of a Multicenter Randomized Clinical Trial (LOGICA-Trial)

Arjen van der Veen et al. J Gastrointest Surg. 2023 Oct.

Abstract

Background: Laparoscopic gastrectomy could reduce pain and opioid consumption, compared to open gastrectomy. However, it is difficult to judge the clinical relevance of this reduction, since these outcomes are reported in few randomized trials and in limited detail.

Methods: This secondary analysis of a multicenter randomized trial compared laparoscopic versus open gastrectomy for resectable gastric adenocarcinoma (cT1-4aN0-3bM0). Postoperative pain was analyzed by opioid consumption in oral morphine equivalents (OME, mg/day) at postoperative day (POD) 1-5, WHO analgesic steps, and Numeric Rating Scales (NRS, 0-10) at POD 1-10 and discharge. Regression and mixed model analyses were performed, with and without correction for epidural analgesia.

Results: Between 2015 and 2018, 115 patients in the laparoscopic group and 110 in the open group underwent surgery. Some 16 patients (14%) in the laparoscopic group and 73 patients (66%) in the open group received epidural analgesia. At POD 1-3, mean opioid consumption was 131, 118, and 53 mg OME lower in the laparoscopic group, compared to the open group, respectively (all p < 0.001). After correcting for epidural analgesia, these differences remained significant at POD 1-2 (47 mg OME, p = 0.002 and 69 mg OME, p < 0.001, respectively). At discharge, 27% of patients in the laparoscopic group and 43% patients in the open group used oral opioids (p = 0.006). Mean highest daily pain scores were between 2 and 4 at all PODs, < 2 at discharge, and did not relevantly differ between treatment arms.

Conclusion: In this multicenter randomized trial, postoperative pain was comparable between laparoscopic and open gastrectomy. After laparoscopic gastrectomy, this was generally achieved without epidural analgesia and with fewer opioids.

Trial registration: NCT02248519.

Keywords: Gastrectomy; Gastric cancer; Laparoscopic gastrectomy; Opioid consumption; Pain; Randomized trial; Surgery.

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Conflict of interest statement

Misha D. P. Luyer

Consulting or Advisory Role: Galvani, Medtronic.

Research Funding: Dutch Cancer Foundation.

Travel, Accommodations, Expenses: Medtronic.

Grard A. P. Nieuwenhuijzen

Consulting or Advisory Role: Medtronic.

Research Funding: Medtronic.

Jelle P. Ruurda

Consulting or Advisory Role: Intuitive Surgical.

Richard van Hillegersberg

Consulting or Advisory Role: Intuitive Surgical, Medtronic.

No other potential conflicts of interest were reported.

Figures

Fig. 1
Fig. 1
Mean pain scores (highest of the day) at POD 1–10 and discharge, with 95% confidence intervals. p-values from the mixed model between group comparison at POD 1–5 and linear regression at discharge (Table 2) are displayed above the brackets. * = p-value corrected for epidural analgesia. POD, postoperative day; D, day of discharge; n, number of patients. Of note, day of discharge is variable per patient and often not directly following POD 10
Fig. 2
Fig. 2
Analgesic steps at POD 1–10 during hospital admission and at discharge. Of note, day of discharge is variable per patient and often not directly following POD 10. p-values from the Poisson regressions are displayed above the brackets. * = p-value corrected for epidural analgesia. L, laparoscopic group; O, open group; POD, postoperative day; D, day of discharge; n, number of patients
Fig. 3
Fig. 3
Mean total opioid dosages at POD 1–5. 95% confidence intervals are displayed for the mean total opioid dosages (the sum of the 4 administration routes). p-values from the mixed model between group comparison (Table 2) are displayed above the brackets. * = p-value corrected for epidural analgesia. L, laparoscopic group; O, open group; POD, postoperative day; IM, intramuscular; n, number of patients
See this image and copyright information in PMC

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