Efficacy of Different Analgesic Techniques on Postoperative Opioid Consumption and Pain After Pancreaticoduodenectomy: A Systematic Review and Network Meta-Analysis

World J Surg. 2026 May 6. doi: 10.1002/wjs.70348. Online ahead of print.

ABSTRACT

OBJECTIVE: Various analgesic techniques have been employed for pain management in pancreatoduodenectomy (PD). However, the optimal technique remains unclear. This network meta-analysis seeks to appraise the efficacy and adverse effects of different analgesic techniques.

METHODS: Cochrane, Embase, Web of Science, and PubMed databases were searched up to January 10, 2025. Clinical studies on pain control following PD were included. Primary search terms included PD and pain. Two reviewers separately screened studies, extracted data, and evaluated the risk of bias. A third reviewer resolved their dissents. The risk of bias was assessed via the NIH quality assessment tool. Data analysis was carried out via R version 4.4.1. The primary outcome was postoperative opioid consumption, and the secondary outcomes included pain scores at 24 and 48 h after surgery and postoperative nausea and vomiting (PONV). Effect sizes were presented as standardized mean differences (SMD), mean differences (MD), and relative risk (RR).

RESULTS: A total of 10 studies were included, including five randomized controlled trials and five cohort studies, involving a total of 975 patients. The network meta-analysis revealed that compared to epidural block with other analgesia, parecoxib-IV was most effective in reducing opioid consumption after surgery (SMD: -3.7, 95% CI: [-4.3, -4.1]). Additionally, wound infiltration (WI), transversus abdominis plane (TAP) block, electrical muscle stimulation, and intrathecal morphine (ITM) + TAP can substantially reduce opioid consumption after surgery. For pain scores, parecoxib-IV was most effective in controlling postoperative pain at rest (MD: -0.32, 95% CI: [-4.9, -0.15]). Regarding PONV, WI (RR: 0.70, 95% CI: [0.51, 0.94]) and acetaminophen-IV (RR: 0.35, 95% CI: [0.099, 0.94]) were linked to fewer adverse events.

CONCLUSIONS: Compared with epidural block, intravenous parecoxib was ranked as the most effective intervention for reducing postoperative opioid consumption. WI, TAP block, electrical muscle stimulation, and ITM + TAP also demonstrated superior effects in reducing opioid consumption relative to epidural analgesia. Regarding secondary outcomes, intravenous parecoxib was the most effective in reducing postoperative pain scores at rest, while both WI and intravenous acetaminophen were associated with a lower incidence of PONV. These findings suggest that alternative analgesic strategies, particularly intravenous parecoxib, may offer advantages over epidural block. Given the limited number of studies currently included, these conclusions need to be further validated by future high-quality research.

TRIAL REGISTRATION: PROSPERO registration: https://www.crd.york.ac.uk/prospero/ (CRD: 420251030763).

PMID:42093135 | DOI:10.1002/wjs.70348