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Colonic surgery patients were studied to measure: the influence of continuous thoracic epidural analgesia (TEA) on a postoperative pain score, the time till onset of defaecation, blood loss, postoperative temperature elevations, rate of bacterial contamination of wounds and urine, and general surgical complications. Group I patients (n = 57) received general anaesthesia and TEA for the operation, followed by continuous TEA (0.25 per cent bupivacaine) for 72 h. Group II patients (n = 59) received general anaesthesia for the operation, followed by systemic analgesia on request. Significant beneficial effects of TEA in group I were demonstrated by lower pain scores in the first 24 h after surgery and earlier defaecation. However, there were fewer temperature elevations in group II. There was no significant difference between the groups in terms of positive bacteriological cultures, blood loss, need for postoperative mechanical ventilation and complications. However, there was a trend toward a higher rate of rectal anastomotic breakdown, increased blood replacement and intensive care therapy, and longer hospitalization in group I. These results do not suggest any significant beneficial therapeutic effect of continuous TEA in colonic surgery compared with a conventional systemic analgesic regimen. In selected patients (i.e. those with severe pain or those prone to develop postoperative ileus) continuous TEA may be beneficial.

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The choice of optimal concept in the therapy of severe peritonitis is essential to outcome. In approximately 10-15% of patients suffering severe peritonitis, single-stage surgery is not sufficient and additional operative therapy is required. Different therapeutic strategies such as the open-package procedure, staged abdominal repair, and on-demand relaparotomy have been developed for these situations. However, it is difficult to compare the effectiveness of each regimen because stratification tools are lacking. This paper describes advantages and disadvantages of the various therapeutic options in peritonitis and their clinical implementation.

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