Postoperative Protocol
pain
As previously described, multiple quality control measures were included in the trial, and the treatment protocols were in accordance with the guidelines for Enhanced Recovery After Surgery (ERAS).Postoperative pain protocols were left to the discretion of each participating hospital and did not differ between treatment arms, except for epidural analgesia. For open gastrectomy, epidural analgesia was the standard unless there were (relative) contraindications. For laparoscopic gastrectomy, epidural analgesia was not allowed according to the trial protocol, and pain control was achieved via intravenous opioids, oral opioids, or paracetamol only. Patients that received epidural analgesia anyway were regarded protocol-violations but analyzed according to the intention-to-treat principle nonetheless. Epidurals were placed between intervertebral levels T5–T10. All infusions contained local anesthetics (all hospitals used bupivacaine) and an opioid, since the combination of local anesthetics with opioids provides superior analgesia and is thus recommended in recognized guidelines.