Abstract / Summary
Abstract Background For laparoscopic gastrectomy, patient-controlled intravenous analgesia (PCIA) alone is often insufficient and may contribute to excessive opioid consumption. Current Enhanced Recovery After Surgery (ERAS) guidelines recommend multimodal analgesia (MMA). This study evaluated whether an MMA regimen—PCIA combined with poloxamer 407-based ropivacaine hydrogel and scheduled intravenous (IV) acetaminophen—improves postoperative outcomes compared to conventional PCIA. Methods This single-center retrospective cohort study (March 2022–February 2024) included patients undergoing totally laparoscopic distal gastrectomy (TLDG) for gastric cancer. The PCIA group ( n = 168) received PCIA with additional analgesics as needed; the MMA group ( n = 131) additionally received poloxamer 407-based ropivacaine hydrogel wound infiltration and scheduled IV acetaminophen. The primary endpoint was postoperative pain intensity from the Post-Anesthesia Care Unit (PACU) to postoperative day (POD) 5. Secondary endpoints included additional rescue opioid consumption, clinical pathway (CP) completion, recovery parameters, opioid-related adverse events (ORAEs), and postoperative complications. Results NRS scores were significantly lower in the MMA group from POD 0 through POD 3, and on the morning of POD 4 (all p < 0.05); the difference at PACU admission was small and did not reach statistical significance ( p = 0.184). Additional rescue opioid consumption was consistently reduced, most pronounced on POD 0 ( p < 0.001). The MMA group showed higher CP completion (79.4% vs. 63.1%, p = 0.002), shorter hospital stay (6.7 vs. 7.7 days, p = 0.014). ORAEs were lower (nausea 6.9% vs. 25.6%, p < 0.001; urinary retention 3.8% vs. 11.3%, p = 0.018). Overall complications were fewer in the MMA group (3.1% vs. 20.8%, p < 0.001), particularly delayed gastric emptying (0.8% vs. 9.5%, p = 0.001) and pneumonia (0% vs. 3.6%, p = 0.037). No significant difference in liver enzyme elevations was detected within the limits of this single-center cohort. Conclusions This MMA protocol provided statistically superior, though clinically modest, analgesia, reduced additional rescue opioid requirements and ORAEs, and facilitated faster recovery with fewer complications after TLDG. Given the large relative magnitude of the complication reductions, particularly for DGE, these findings represent an exploratory association rather than a confirmed causal effect of the analgesic protocol and should be interpreted with appropriate caution pending confirmation in a prospective study. This simple, catheter-free, opioid-sparing regimen may represent a safe and effective ERAS strategy for gastric cancer surgery.