Postoperative Pain Treatment After Pancreatic Surgery. A Protocol for Systematic Review With Meta-Analysis and Trial Sequential Analysis

BACKGROUND: Pancreatic surgical procedures are technically challenging and associated with a high level of surgical stress and postoperative pain. The most common surgical intervention in the pancreas is a pancreatoduodenectomy seconded by a distal pancreas resection and total pancreatectomy. Optimal pain management is crucial for ensuring early mobilization and has been shown to reduce the length of hospital stay and the incidence of postoperative complications. The optimal strategy, however, remains a matter of controversy, and the advantages and harms related to the use of different analgesic interventions remain unclear.

OBJECTIVES: This systematic review aims to investigate the benefits and harms of analgesic interventions in adult patients undergoing total pancreatectomy, pancreatoduodenectomy and distal pancreatectomy.

METHODS: The protocol adheres to The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. A search will be conducted in Medline, EMBASE, and The Cochrane Library's CENTRAL for published and ongoing trials. We will include randomized clinical trials that assess the postoperative effect of an intervention compared to a control. A risk of bias assessment will be performed according to risk of bias volume 2 (ROB2), and trial sequential analysis will be conducted. Furthermore, a meta-analysis will be conducted in accordance with the recommendations outlined in the Cochrane Handbook for Systematic Reviews and Interventions. The Review Manager Software version 5.4 will be used to handle the analyses. The overall quality of evidence for outcomes derived from the meta-analysis, risk of bias, and trial sequential analysis will be evaluated using the GRADE approach.