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

Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland.
Langenbeck s Archives of Surgery (Impact Factor: 2.19). 04/2008; 393(2):213-8. DOI: 10.1007/s00423-007-0177-2
Source: PubMed


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.
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.
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.
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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Available from: Tomasz Stefaniak
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    • "Considerably, aggressive conservative treatment with eager use of opioids may further lead to diminishing of quality of life of the patients, predominantly in the aspects of social life and everyday functioning (Ruetsch 2010). That fact should be carefully considered in light of the long-term survival of CP patients (Stefaniak et al. 2008) and subsequently, the necessity for long-term opioid therapy and increased risk of iatrogenic opioid addiction (Nishimori et al. 2006; Ruetsch 2010). Therefore, apart from conservative pain treatment utilised in chronic pancreatitis, special attention must be given to invasive methods like neurolytic celiac plexus block (NCPB), and thoracoscopic splanchnicectomy (TS) that provide a chance for reduction of intensity of conservative treatment and/or prolonging the effectiveness of the drugs instituted and prevention of fast drug dose escalation (Basinski et al. 2005; Stefaniak et al. 2005). "
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