Differences in Epidural and Analgesic Use in Patients with Apparent Stage I Endometrial Cancer Treated by Open versus Laparoscopic Surgery: Results from the Randomised LACE Trial

Objectives. We compared postoperative analgesic requirements between women with early stage endometrial cancer treated by total abdominal hysterectomy (TAH) or total laparoscopic hysterectomy (TLH). Methods. 760 patients with apparent stage I endometrial cancer were treated in the international, multicentre, prospective randomised trial (LACE) by TAH ( ) or TLH ( ) (2005–2010). Epidural, opioid, and nonopioid analgesic requirements were collected until ten months after surgery. Results. Baseline demographics and analgesic use were comparable between treatment arms. TAH patients were more likely to receive epidural analgesia than TLH patients (33% versus 0.5%, ) during the early postoperative phase. Although opioid use was comparable in the TAH versus TLH groups during postoperative 0–2 days (99.7% versus 98.5%, ), a significantly higher proportion of TAH patients required opioids 3–5 days (70% versus 22%, ), 6–14 days (35% versus 15%, ), and 15–60 days (15% versus 9%, ) after surgery. Mean pain scores were significantly higher in the TAH versus TLH group one (2.48 versus 1.62, ) and four weeks (0.89 versus 0.63, ) following surgery. Conclusion. Treatment of early stage endometrial cancer with TLH is associated with less frequent use of epidural, lower post-operative opioid requirements, and better pain scores than TAH. 1. Introduction Endometrial cancer is the most common gynaecological cancer in developed countries and the current standard of treatment is hysterectomy and bilateral salpingectomy using an open abdominal surgical approach [1]. Three recent clinical trials have shown that a laparoscopic approach to surgery results in shorter hospital stay and fewer adverse events compared with open surgery [2–5] and two of these trials found better quality of life outcomes [3, 5]. Epidural and nonepidural opioid analgesia may be used for pain management following both, open or laparoscopic surgery, and guidelines are available for anaesthetic prescription and monitoring [6]. Although epidural analgesia may decrease the risk of cardiovascular and pulmonary complications in high-risk patients undergoing major surgery, it is invasive, costly, time consuming, and labour intensive [7]. There is developing evidence that other forms of regional analgesia may be more cost effective without sacrificing efficacy [7, 8]. Minimally invasive procedures have been found to be associated with smaller postoperative analgesia requirements compared with open surgery in patients treated for gynaecological cancers [9–12] and in ovarian metastasectomy from gastric cancer [13].