Intravenous Acetaminophen vs Thoracic Epidural Analgesia After Minimally Invasive Gastrectomy BJS Open | June 2026
Introduction:
Thoracic epidural analgesia (TEA) has long been considered the standard for postoperative pain control after gastrectomy. However, with the increasing adoption of minimally invasive gastrectomy, less invasive analgesic strategies may provide equivalent pain relief while avoiding epidural-related complications. This multicenter randomized non-inferiority trial compared scheduled intravenous (IV) acetaminophen with thoracic epidural analgesia.
Why was this study needed?
- Thoracic epidural analgesia is associated with hypotension, urinary retention, and technical complications.
- Minimally invasive gastrectomy causes less postoperative pain than open surgery.
- Enhanced Recovery After Surgery (ERAS) pathways favor simpler, opioid-sparing analgesic strategies.
- High-quality randomized evidence comparing IV acetaminophen with epidural analgesia has been limited.
- Simplifying postoperative pain management could improve recovery and reduce resource utilization.
Results:
- Scheduled IV acetaminophen was non-inferior to thoracic epidural analgesia for postoperative pain control, with comparable pain scores following minimally invasive gastrectomy.
- Rescue analgesic requirements, patient satisfaction, and postoperative recovery were similar between the two treatment groups.
- The findings suggest that routine epidural analgesia may not be necessary for patients undergoing minimally invasive gastrectomy.
Clinical Impact:
This trial supports a shift toward simpler, opioid-sparing analgesic protocols within ERAS pathways. Scheduled IV acetaminophen may provide effective postoperative pain control while avoiding the potential risks, technical complexity, and resource requirements associated with thoracic epidural analgesia in minimally invasive gastric surgery.
Bottom Line:
Scheduled intravenous acetaminophen provides postoperative pain control comparable to thoracic epidural analgesia after minimally invasive gastrectomy. These findings challenge the routine use of epidural analgesia and support a less invasive ERAS-based analgesic strategy for appropriately selected patients.
