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. 2025 Sep;77(5):1515-1524.
doi: 10.1007/s13304-025-02268-0. Epub 2025 May 30.

Impact of analgesia modality on postoperative recovery after laparoscopic distal pancreatectomy

Giovanni Guarneri #  1   2 , Stefano Turi #  3 , Nicolò Pecorelli #  4   5 , Giuseppe Culicchia  6 , Alessia Vallorani  6 , Renato Meani  3 , Luigi Beretta  3   6 , Massimo Falconi  1   6
Affiliations

Impact of analgesia modality on postoperative recovery after laparoscopic distal pancreatectomy

Giovanni Guarneri et al. Updates Surg. 2025 Sep.

Abstract

In the context of enhanced recovery pathways (ERP) for colorectal surgery, thoracic epidural analgesia (TEA) delays recovery compared to opioid-based patient-controlled intravenous analgesia (PCA). Limited evidence is available for laparoscopic pancreatic surgery. The objective of this study was to evaluate the impact of different analgesic modalities on the time to functional recovery (TFR) following laparoscopic distal pancreatectomy (LDP). Clinical data for consecutive patients undergoing LDP were reviewed. All patients were treated within an ERP including a multimodal analgesia protocol. The main analgesic techniques used were TEA, intravenous morphine PCA, and patient-controlled sublingual sufentanil tablet system (SSTS). TFR was defined as postoperative days (PODs) needed to achieve adequate mobilization, return of gastrointestinal function, sufficient oral intake with no need for intravenous infusion, and adequate pain control with oral analgesia. Overall, 336 patients were included; 109 (32%) patients received TEA, 124 (37%) PCA, and 103 (31%) SSTS. TFR was significantly shorter for the SSTS group with median of 4 [IQR 3-5] days compared to 5 [4-6] days in both the TEA and PCA groups (p < 0.001). This difference was due to faster time to sufficient oral intake and adequate pain control with oral analgesia. On POD1, patients treated with TEA had better pain control compared to other modalities; the median NRS pain score at rest was 0 [0-3] compared to 2 [0-4] for both PCA and SSTS groups (p = 0.003). Multivariate regression showed that SSTS was associated with a 17% reduction (95% CI - 29 to - 5; p = 0.005) of TFR compared to TEA. Patients treated with SSTS had a significantly shorter TFR after LDP compared with other analgesic modalities with no difference in adverse events.

Keywords: Analgesia; Distal pancreatectomy; Laparoscopy; Outcome and process assessment (health care); Pancreatic neoplasms; Postoperative recovery.

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Conflict of interest statement

Declarations. Conflict of interest: Giovanni Guarneri, Stefano Turi, Nicolò Pecorelli, Giuseppe Culicchia, Alessia Vallorani, Renato Meani, Luigi Beretta, and Massimo Falconi have no conflicts of interests or financial ties to disclose.

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