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Comparison of the Analgesic Efficacy of Opioid-Sparing Multimodal Analgesia and Morphine-Based Patient-Controlled Analgesia in Minimally Invasive Surgery for Colorectal Cancer

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Abstract

Background

A multimodal analgesia (MMA) protocol has shown the effect of postoperative pain control and reduced the postoperative opioid consumption. However, it was questionable whether MMA could replace opioid-based patient-controlled analgesia (PCA) for postoperative pain control. Therefore, this study aimed to investigate whether an MMA protocol is non-inferior to opioid-based PCA for pain management after a minimally invasive colorectal cancer surgery.

Methods

A randomized, open-label, non-inferiority clinical trial was conducted on patients undergoing laparoscopic or robotic resection of colorectal cancer. The patients were randomly assigned to either the PCA or MMA group. The MMA protocol included pregabalin, tramadol, wound infiltration, and transversus abdominis plane block. The primary outcome was the numeric rating scale (NRS) score for pain at rest 24 h postoperatively.

Results

Ninety-seven patients were included in the intention-to-treat analysis. The mean difference in NRS score at rest at 24 h was 0.25 (95% confidence interval, − 0.61 to 1.11). This result demonstrated the non-inferiority of MMA to PCA in our non-inferiority margin (− 1). Compared with the PCA group, the median remifentanil dose (996 vs. 654 μg; p < 0.001) and time in the post-anesthesia care unit (35 vs. 25 min; p < 0.001) were significantly less in the MMA group.

Conclusions

Our MMA protocol successfully controlled postoperative pain and was non-inferior to morphine-based PCA based on patient-reported pain intensity, with no significant increase in adverse events. These results will help construct a strategy to reduce conventional opioid prescriptions for pain management after a minimally invasive colorectal cancer surgery.

Trial Registration Number Trial Registration Clinical Research Information Service Identifier: KCT0002593

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Acknowledgements

We acknowledge the dedicated efforts of So Young Jeong, who served as a research investigator and appreciate the patients for their participation in this trial.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Kyungpook National University Chilgok Hospital, Daegu, Korea

    Jinseok Yeo, Jay Kyoung Kim & Jinyoung Oh

  2. Department of Colorectal Surgery, Kyungpook National University Chilgok Hospital, Daegu, Korea

    Jun Seok Park, Gyu-Seog Choi, Hye Jin Kim & Soo Yeun Park

  3. School of Medicine, Kyungpook National University, Daegu, Korea

    Jinseok Yeo, Jun Seok Park, Gyu-Seog Choi, Hye Jin Kim, Jinyoung Oh & Soo Yeun Park

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  1. Jinseok Yeo
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Contributions

SYP, JSP, JY contributed to the conception and design of the manuscript. SYP, JSP, JY, JKK, JO contributed to the acquisition of data. GSC, HJK were involved in the analysis and interpretation of data. SYP, JSP, JY contributed to the drafting the article. All authors contributed to the critical revision of the article for important intellectual content and the final approval of the version to be published. SYP, JSP contributed equally to this study as co-corresponding authors.

Corresponding author

Correspondence to Soo Yeun Park.

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Conflict of interest

Drs. Jinseok Yeo, Jun Seok Park, Gyu-Seog Choi, Hye Jin Kim, Jay Kyoung Kim, Jinyoung Oh, and Soo Yeun Park have no conflicts of interest or financial ties to disclose.

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Yeo, J., Park, J.S., Choi, GS. et al. Comparison of the Analgesic Efficacy of Opioid-Sparing Multimodal Analgesia and Morphine-Based Patient-Controlled Analgesia in Minimally Invasive Surgery for Colorectal Cancer. World J Surg 46, 1788–1795 (2022). https://doi.org/10.1007/s00268-022-06473-5

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  • DOI: https://doi.org/10.1007/s00268-022-06473-5

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