Comparison of epidural anesthesia and intravenous self-control analgesia on postoperative recovery quality in duodenectomy

BACKGROUND Pancreaticoduodenectomy is associated with significant postoperative pain and morbidity. Both epidural anesthesia (EA) and intravenous patient-controlled analgesia (IVPCA) are commonly used for pain management, yet their comparative effectiveness on postoperative recovery quality remains unclear. AIM To evaluate and compare the effects of these two analgesic techniques on recovery outcomes following pancreaticoduodenectomy. METHODS We retrospectively analyzed 186 patients (92 EA; 94 IVPCA) who underwent pancreaticoduodenectomy between January 2018 and December 2022, comparing outcomes including pain scores, ambulation time, bowel function recovery, hospital stay, complications, and patient satisfaction, with propensity score matching used to minimize selection bias, followed by appropriate statistical analysis. RESULTS After propensity score matching, EA patients demonstrated significantly lower pain scores (P < 0.001), earlier ambulation (28.5 ± 6.3 hours vs 41.2 ± 8.7 hours, P < 0.001), faster return of bowel function (65.3 ± 12.6 hours vs 78.9 ± 15.4 hours, P < 0.001), shorter hospital stays (14.2 ± 3.7 days vs 16.8 ± 4.2 days, P = 0.003), and higher satisfaction scores (8.3 ± 1.2 vs 7.1 ± 1.5, P < 0.001) compared to IVPCA patients. CONCLUSION EA provides superior pain control, facilitates earlier ambulation and return of bowel function, shortens hospital stay, and improves patient satisfaction compared to IVPCA in patients undergoing pancreaticoduodenectomy. Despite a higher incidence of hypotension, EA appears to be the preferable analgesic technique for enhancing postoperative recovery quality in pancreaticoduodenectomy.