Effect of epidural analgesia vs. combined intravenous patient-controlled analgesia and transversus abdominis plane block on postoperative outcomes after radical cystectomy.

Abstract

875 Background: Intravenous patient-controlled analgesia (IV-PCA) and epidural analgesia are commonly used methods for postoperative pain management following major surgery. Although previous systematic reviews have suggested that epidural analgesia may provide superior pain control compared to IV-PCA, it is also associated with potential complications such as hematoma, abscess formation, and catheter migration. Ultrasound-guided transversus abdominis plane (TAP) block is a simple, safe, and minimally invasive regional anesthesia technique. However, the combined effect of IV-PCA and TAP block on postoperative outcomes remains unclear. Methods: This multicenter retrospective study included 473 patients who underwent radical cystectomy (RC) under general anesthesia. Patients were divided into two groups: those who received epidural analgesia (epidural group) and those who received IV-PCA combined with TAP block (study group). The primary endpoint was the rate of perioperative complications of grade ≥3. Secondary endpoints included length of hospital stay after RC, time to initiation of oral feeding, and 90-day readmission rate. Multivariable analysis was performed to identify risk factors associated with grade ≥3 complications. Results: The median age was 69 years. Of the 473 patients, 355 (75%) received epidural analgesia and 118 (25%) received IV-PCA plus TAP block. No TAP block-related complications were observed. The rates of any-grade and grade ≥3 perioperative complications did not differ significantly between the epidural and study groups (64% vs. 68%, P = 0.469; 23% vs. 19%, P = 0.334, respectively). In univariable analyses, age and type of urinary diversion were significantly associated with grade ≥3 complications, whereas sex, performance status, body mass index, American Society of Anesthesiologists physical status, and robot-assisted radical cystectomy were not. After adjusting for these confounding variables, IV-PCA combined with TAP block was not significantly associated with an increased risk of grade ≥3 complications. The study group had significantly shorter hospital stays and earlier initiation of oral feeding compared to the epidural group ( P = 0.007 and P < 0.001, respectively). The 90-day readmission rates were comparable between the epidural and study groups (29% vs. 25%, P = 0.435). Conclusions: Although IV-PCA combined with TAP block did not reduce the rate of perioperative complications, it was associated with shorter hospital stays and earlier initiation of oral intake following RC. Multivariable analysis for grade ≥3 complications. Multivariable Factor P value Odds ratio 95% CI Age Continuous 0.044 1.029 1.001–1.059 Urinary diversion Neobladder <0.001 0.420 0.262–0.674 IV-PVC plus TAP Performed 0.137 0.664 0.387–1.140