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Opioid use determines success of videothoracoscopic splanchnicectomy in chronic pancreatic pain patients

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Abstract

Objective

Videoscopic splanchnicectomy (VSPL) is a method of pain relief in chronic pancreatitis patients. Because this method is not equally effective in all patients, this study was designed to identify the factors determining the unfavorable results of VSPL.

Materials and methods

This is a non-randomized prospective case-controlled study designed to compare a group of patients suffering from chronic pancreatitis treated with VSPL (N = 48) versus a group of patients treated symptomatically (N = 42). The outcome was measured as the intensity of pain ailments [visual analog scale (VAS)-pain scale] and subjective satisfaction of the patients from the surgical treatment [Functional Assessment of Chronic Illness Therapy-Treatment Satisfaction (FACIT-TS)]. The predictive variables considered in this study were: age, sex, emotional status, social support (the two last variables were measured by subscales of quality-of-life questionnaire from the group of FACIT), history of previous surgical treatment, and opioid use for at least 3 months before VSPL. The follow-up was 18 months. Logistic regression was performed using dichotomized pain as outcome variable: high score more than 66.7 on VAS scale and low under 50 points on VAS scale 18 months after VSPL.

Results

VSPL significantly reduced the pain ailments at all points of the study when compared to the control. However, the pain intensity at the end of the study was higher than directly after the surgery. In the patients treated with opioids before the surgery, the pain intensity was significantly higher than in the patients not using this group of drugs. Logistic regression revealed that opioid administration before VSPL was the most important predictor of high pain scores 18 months after the surgery.

Conclusion

When planning the VSPL in the treatment of pain in patients suffering from chronic pancreatitis, it is necessary to take into consideration the previous chronic use of opioids, as this variable can significantly influence poorer results of this surgical pain management.

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Authors and Affiliations

  1. Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland

    Tomasz Stefaniak, Wojciech Makarewicz, Lukasz Kaska, Jarek Kobiela, Aleksander Stanek, Andrzej J. Lachinski & Zbigniew Śledziński

  2. Department of Psychology and Health, Tilburg University, Tilburg, The Netherlands

    Ad Vingerhoets

  3. Research Institute for Psychology and Health, Tilburg University, Tilburg, The Netherlands

    Ad Vingerhoets

  4. Department of Anaesthesiology and Intensive Care, Medical University of Gdansk, Gdansk, Poland

    Barbara Kwiecińska

Authors
  1. Tomasz Stefaniak
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  2. Ad Vingerhoets
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  3. Wojciech Makarewicz
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  4. Lukasz Kaska
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  5. Jarek Kobiela
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  6. Barbara Kwiecińska
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  7. Aleksander Stanek
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  8. Andrzej J. Lachinski
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  9. Zbigniew Śledziński
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Corresponding author

Correspondence to Tomasz Stefaniak.

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Stefaniak, T., Vingerhoets, A., Makarewicz, W. et al. Opioid use determines success of videothoracoscopic splanchnicectomy in chronic pancreatic pain patients. Langenbecks Arch Surg 393, 213–218 (2008). https://doi.org/10.1007/s00423-007-0177-2

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  • DOI: https://doi.org/10.1007/s00423-007-0177-2

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