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Background Epidural analgesia is conventionally used as the mainstay of analgesia in open abdominal surgery but has a small life-changing risk of complications (epidural abscesses or haematomas). Local wound-infusion could be a viable alternative and are associated with fewer adverse effects. Methods A retrospective observational analysis of individuals undergoing open hepato-pancreato-biliary surgery over 1 year was undertaken. Patients either received epidural analgesia (EP) or continuous wound infusion (WI) + IV patient controlled anaesthesisa (PCA) with an intraoperative spinal opiate. Outcomes analyzed included length of stay, commencement of oral diet and opioid use. Results Between Jan 2016- Dec 2016, 110 patients were analyzed (WI  n=35 , EP  n=75 ). The median length of stay (days) was 8 in both the WI and EP group ( p=0.846 ), the median time to commencing oral diet (days) was 3 in WI group and 2 in EP group ( p=0.455 ). There was no significant difference in the amount of oromorph, codeine or tramadol (mg) between WI and EP groups ( p = 0.829 ,  p=0.531, p=0.073,  respectively). Conclusions Continuous wound infusion + IV PCA provided adequate analgesia to patients undergoing open hepato-pancreato-biliary surgery. It was non-inferior to epidural analgesia with respect to hospital stay, commencement of oral diet and opioid use.

Retrospective observational study of patient outcomes with local wound infusion vs epidural analgesia after open hepato-pancreato-biliary surgery