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Randomized Controlled Trial
. 2025 Jul 1;282(1):29-36.
doi: 10.1097/SLA.0000000000006551. Epub 2024 Oct 3.

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

Minke L Feenstra  1   2 , Cezanne D Kooij  3 , Wietse J Eshuis  1 , Eline M de Groot  3 , Jeroen Hermanides  2 , B Feike Kingma  3 , Suzanne S Gisbertz  1 , Jelle P Ruurda  3 , Freek Daams  1 , Marije Marsman  4 , Oscar F C van den Bosch  5 , Werner Ten Hoope  2 , Lucas Goense  3 , Misha D P Luyer  6 , Grard A P Nieuwenhuijzen  6 , Harm J Scholten  7 , Marc Buise  8 , Marc J van Det  9 , Ewout A Kouwenhoven  9 , Franciscus van der Meer  10 , Geert W J Frederix  11 , Markus W Hollmann  2 , Edward Cheong  12 , Mark I van Berge Henegouwen  1 , Richard van Hillegersberg  3
Affiliations
Randomized Controlled Trial

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

Minke L Feenstra et al. Ann Surg. .

Abstract

Objective: To compare the quality of recovery in patients receiving epidural or paravertebral analgesia for minimally invasive esophagectomy (MIE).

Background: 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 4 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 significantly 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 vs 2; P <0.001 and median 1 vs 2; P =0.033). More epidural patients required vasopressor medication on POD1 (38.3% vs 13.3%; P <0.001). Urinary catheters were removed earlier in the paravertebral group (median POD3 vs 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 the superiority of paravertebral over epidural analgesia regarding the quality of recovery on POD3 after MIE. Both techniques are effective and can be offered in clinical practice.

Keywords: epidural analgesia; esophageal cancer; minimally invasive esophagectomy; paravertebral analgesia.

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Conflict of interest statement

J.P.R. reported serving an advisory or consulting role for Intuitive Surgical and Medtronic. M.D.P.L. reported receiving research grants from Medtronic outside the submitted work. G.A.P.N. reported serving a consulting or advisory role for Medtronic. M.B. reported serving a consulting or advisory role for Medtronic. M.J.v.D. reported serving a consulting or advisory role for Intuitive Surgical. E.A.K. reported serving a consulting or advisory role for Intuitive Surgical. M.W.H. reported serving roles as Executive Section Editor of Pharmacology with Anesthesia & Analgesia, Section Editor of Anesthesiology with J Clin Med , Editor with Front Physiol , and research support and honorarium for consultancy by PAION, Medical Developments & IDD Pharma. M.I.v.B.H. reported serving consulting or advisory roles for Viatris, Johnson & Johnson, BBraun, Stryker, and Medtronic, and all fees were paid to the institution. R.v.H. reported serving a consulting or advisory role for Intuitive Surgical, Medtronic, and Olympus. The remaining authors report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Trial flowchart. Of the 199 patients who underwent random assignment, 192 patients were included in the intention-to-treat analysis: 94 in the epidural group and 98 in the paravertebral group. A total of 179 patients underwent Ivor Lewis minimally invasive esophagectomy and their allocated analgesia modality according to the protocol: 86 in the epidural group and 93 in the paravertebral group. MIE indicates minimally invasive esophagectomy; ITT, intention-to-treat; PP, per protocol.
See this image and copyright information in PMC

References

    1. DiSiena M, Perelman A, Birk J, et al. . Esophageal cancer: an updated review. South Med J. 2021;114:161–168. - PubMed
    1. Yibulayin W, Abulizi S, Lv H, et al. . Minimally invasive oesophagectomy versus open esophagectomy for resectable esophageal cancer: a meta-analysis. World J Surg Oncol. 2016;14:304. - PMC - PubMed
    1. Enzinger PC, Mayer RJ. Esophageal cancer. N Engl J Med. 2003;349:2241–2252. - PubMed
    1. Morgan E, Soerjomataram I, Rumgay H, et al. . The global landscape of esophageal squamous cell carcinoma and esophageal adenocarcinoma incidence and mortality in 2020 and projections to 2040: new estimates from GLOBOCAN 2020. Gastroenterology. 2022;163:649–658.e2. - PubMed
    1. Lagergren J, Smyth E, Cunningham D, et al. . Oesophageal cancer. Lancet. 2017;390:2383–2396. - PubMed

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