Differences in postoperative pain management in patients with Ileitis Crohn and diverticulitis– a matched pair analysis

TL;DR

This study compares postoperative pain management and outcomes in patients with Crohn's disease and diverticulitis, finding that Crohn's patients require more analgesics but experience similar pain levels.

Contribution

The study provides new clinical insights into postoperative pain differences and analgesic needs in Crohn's disease versus non-IBD patients.

Findings

CD patients had significantly more postoperative complications and higher use of metamizole and co-analgesics.

CD patients had longer opioid use duration but similar pain experience as non-IBD patients based on NRS scores.

Matched-pair analysis showed no significant differences in pain levels or analgesic needs between limited CD and non-IBD patients.

Abstract

Crohn’s disease (CD) belongs to the group of chronic inflammatory bowel diseases (IBD) and is characterized by disease relapse with gastrointestinal symptoms and abdominal pain. Despite continuous development of therapeutical strategies, two thirds of patients suffering from CD need surgical intervention during their lives due to disease progression and complications. It is assumed that CD patients have increased pain experience in the perioperative setting compared to non-IBD patients, but clinical data are rare.

A retrospective single-centre analysis was performed including patients with Ileitis Crohn who underwent open or minimal-invasive (laparoscopic) ileocecal resection between 2017 and 2021. The cohort was compared to patients who received open or minimal-invasive sigmoid resection due to diverticulitis. A descriptive analysis and comparison of pre-existing conditions (e.g. laboratory values, depression, preoperative (co-)analgesics use), postoperative complications, postoperative pain and pain medication was carried out in both cohorts. A matched-pair analysis was performed to determine disease-related pain levels of patients with CD in comparison to non-IBD patients. Both a previously established analgesics and a validated pain scores were used to compare the two groups.

A total of 310 patients, 182 non-IBD patients and 128 CD patients, were analysed. According to Clavien Dindo classification, there were significantly more postoperative complications in CD patients (> 3a) compared to the non-IBD cohort (14.8% vs. 5.5%; p = 0.005). CD patients showed a significantly increased need for metamizole (89.1% vs. 73.1%; p < 0.001), and co-analgesics (18% vs. 4.4%; p < 0.001) postoperatively. Furthermore, the duration of intake of high-potent opioids was significantly longer compared to non-IBD patients (2.4 vs. 1.2 [days]; p = 0.038). These differences in postoperative pain management resulted in equal postoperative pain experience and sensation in patients suffering from Ileitis Crohn and diverticulitis as revealed by NRS scores. Interestingly, a matched-pair analysis between patients with limited CD and non-IBD patients (2x n = 27) showed neither significant differences in postoperative pain levels, need for additional analgesics nor the analgesic score.

Postoperative analgesic regimen need to consider the individual patient’s pain score, pain experience and sensation irrespective of the underlying disease leading to colorectal surgery.

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