Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Aug 15, 2025; 17(8): 108238
Published online Aug 15, 2025. doi: 10.4251/wjgo.v17.i8.108238
Different titration protocols in pain management after radical gastrectomy for gastric cancer patients
Bin-Bin Chen, Wei Tu, Ai-Dan Xia, Miao-Yong Zhu, Zi-Jie Wang
Bin-Bin Chen, Ai-Dan Xia, Miao-Yong Zhu, Department of Hematology and Internal Oncology, Wenzhou People’s Hospital, Wenzhou 325000, Zhejiang Province, China
Wei Tu, Department of Rehabilitation Medicine, 906th Hospital of Joint Logistic Support Force of PLA, Wenzhou 325000, Zhejiang Province, China
Zi-Jie Wang, Department of Tumor Center, Lishui Central Hospital, Lishui 323020, Zhejiang Province, China
Author contributions: Chen BB and Wang ZJ made contributions to conceptualization; Chen BB, Zhu MY, and Wang ZJ contributed to methodology; Chen BB, Xia AD, and Zhu MY contributed to data collection; Chen BB and Tu W contributed to data analysis; Chen BB wrote original draft; Tu W, Xia AD, and Wang ZJ contributed to writing review and editing; Zhu MY and Wang ZJ contributed to project administration; Wang ZJ did supervision. All authors have read and approved the final manuscript.
Supported by Wenzhou Science and Technology Bureau, No. Y20220877.
Institutional review board statement: This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Wenzhou People’s Hospital, No. KY-2022-124.
Informed consent statement: Informed consent statement was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zi-Jie Wang, Department of Tumor Center, Lishui Central Hospital, No. 289 Kuocang Road, Liandu District, Lishui 323020, Zhejiang Province, China. wzj202508@163.com
Received: May 14, 2025
Revised: June 15, 2025
Accepted: July 16, 2025
Published online: August 15, 2025
Processing time: 91 Days and 21.1 Hours
Abstract
BACKGROUND

Effective pain management after radical gastrectomy is crucial for patient recovery. With the promotion of enhanced recovery after surgery protocols, postoperative pain management has become a core component of perioperative care. However, controversy remains regarding the optimal frequency of analgesic titration for pain control.

AIM

To compare the efficacy of 12-hour vs 24-hour titration regimens in postoperative pain management following radical gastrectomy for gastric cancer.

METHODS

This retrospective comparative study analyzed data from 120 patients who underwent radical gastrectomy between January 2021 and December 2022, with 52 patients receiving a 12-hour titration regimen and 68 patients receiving a 24-hour titration regimen. All patients received patient-controlled intravenous analgesia containing sufentanil and tropisetron postoperatively with identical initial settings.

RESULTS

The 12-hour titration group demonstrated significantly lower pain scores at 12 hours postoperatively compared to the 24-hour group (3.2 vs 4.8, P < 0.001); total analgesic consumption (morphine equivalents) was reduced by 28.6% (30 mg vs 42 mg, P < 0.001); postoperative nausea and vomiting decreased by 50% (15% vs 30%, P = 0.02); respiratory depression was less frequent (2% vs 8%, P = 0.04); patient satisfaction was higher (85% vs 65% reporting “very satisfied” or “satisfied”, P < 0.001); and hospital stay was shortened by 12.5% (4.2 days vs 4.8 days, P = 0.02). Cox regression analysis showed that the 12-hour regimen was associated with a lower risk of prolonged high-intensity pain (hazard ratio = 0.65, 95% confidence interval: 0.45-0.93, P = 0.02), and multivariate regression analysis confirmed that the 12-hour regimen was an independent predictor of better overall recovery (β = -0.32, P = 0.01).

CONCLUSION

Compared to the 24-hour titration regimen, the 12-hour titration regimen provided more effective control of early postoperative pain after radical gastrectomy, reduced total analgesic consumption, lowered the incidence of related adverse reactions, improved patient satisfaction, and shortened hospital stays.

Keywords: Radical gastrectomy; Postoperative pain management; Titration regimen; Efficacy; Enhanced recovery after surgery

Core Tip: This study compared 12-hour and 24-hour analgesic titration regimens in postoperative pain management after radical gastrectomy for gastric cancer. Results showed that the 12-hour protocol significantly reduced pain intensity, analgesic consumption, and adverse effects, while improving patient satisfaction and recovery outcomes. The findings support the adoption of more frequent titration strategies within enhanced recovery after surgery protocols to optimize early postoperative pain control, minimize complications, and accelerate recovery. This study provides practical evidence for refining analgesic management and developing individualized postoperative care pathways for patients undergoing major abdominal surgery.