Effects of Perioperative Analgesic Technique on Rate of Recovery after Colon Surgery

Liu, Spencer S.; Carpenter, Randall L.; Mackey, David C.; Thirlby, Richard C.; Rupp, Stephen M.; Shine, Timothy S.J.; Feinglass, Neil G.; Metzger, Philip P.; Fulmer, Jack T.; Smith, Stephen L.

doi:10.1097/00000542-199510000-00015

Cited by 441 publications

(214 citation statements)

References 43 publications

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“…The earlier return of gastrointestinal motility in the epidural bupivacaine/fentanyl group is in agreement with the results of previous studies demonstrating an ileus-reducing effect with local anesthetic-opioid mixtures. 9,10 The shorter duration of ileus in the epidural morphine group, however, contrasts with the results from the majority of randomized studies showing no reduction in ileus in normal patients, who receive epidural opioids. 9,10 We are well aware of the fact that, due to the retrospective nature of the study, the validity of our results and conclusions may be questioned.…”

Section: Méthode : Nous Avons Comparé Rétrospectivement La Période mentioning

confidence: 72%

“…9,10 The shorter duration of ileus in the epidural morphine group, however, contrasts with the results from the majority of randomized studies showing no reduction in ileus in normal patients, who receive epidural opioids. 9,10 We are well aware of the fact that, due to the retrospective nature of the study, the validity of our results and conclusions may be questioned. However, given the reported benefits associated with epidural analgesia in normal patients, 11 we felt compelled to perform a retrospective analysis in order to avoid the ethical dilemma of randomizing high-risk patients to PCA, a presumed suboptimal pain treatment regimen.…”

Section: Méthode : Nous Avons Comparé Rétrospectivement La Période mentioning

confidence: 72%

“…4,5 Epidural analgesia has also been shown to be associated with a lower incidence of deep vein thrombosis, 6 decreased cardiac morbidity, 7 suppression of metabolic neuroendocrine responses 8 and acceleration of postoperative return of gastrointestinal function. 9,10 A recent meta-analysis reported a reduced overall mortality in patients receiving neuraxial blockade for major surgery further justifying the neurological risk and increased preparation time, which may be associated with a regional approach. 11 Few clinical trials have evaluated different types of analgesia in morbidly obese patients after abdominal surgery.…”

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confidence: 99%

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Patient controllediv analgesia is an acceptable pain management strategy in morbidly obese patients undergoing gastric bypass surgery. A retrospective comparison with epidural analgesia

Charghi

Backman

Christou

et al. 2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To examine the hypothesis that pain treatment with patient controlled analgesia (PCA) using iv morphine is a suitable and safe alternative to epidural analgesia in morbidly obese patients undergoing gastric bypass surgery. We retrospectively compared the postoperative periods in all patients undergoing this procedure in our institution between November 1999 and November 2001.M Me et th ho od ds s: : According to their perioperative pain treatment, patients were assigned to a PCA group (with iv morphine) or an epidural analgesia group, in which patients received either intermittent doses of morphine or continuous infusions of bupivacaine/fentanyl. Study endpoints included quality of pain control, incidence of cardiovascular and respiratory complications, analgesia related side effects, time to ambulation and first flatus, length of hospital stay, and wound infections. R Re es su ul lt ts s: : Data from 86 patients were analyzed with 40 patients in the PCA group and 46 patients in the epidural group. Groups were similar with respect to age, body mass index, and gender. The type of analgesia did not affect the quality of pain control at rest, the frequency of nausea and pruritus, the time to ambulation and return of gastrointestinal function, and the length of hospital stay. Patients receiving epidural analgesia had a greater risk of wound infection than subjects with PCA (epidural group: 39%, PCA group: 15%, P = 0.01).

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Section: Méthode : Nous Avons Comparé Rétrospectivement La Période mentioning

confidence: 72%

Section: Méthode : Nous Avons Comparé Rétrospectivement La Période mentioning

confidence: 72%

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confidence: 99%

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Patient controllediv analgesia is an acceptable pain management strategy in morbidly obese patients undergoing gastric bypass surgery. A retrospective comparison with epidural analgesia

Charghi

Backman

Christou

et al. 2003

Can J Anesth/J Can Anesth

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“…Problems associated with thoracic epidural blocks include the increased risk of sympathectomy producing orthostatic hypotension. 1,7 In our institution we have successfully used a lumbar approach for the past ten years for postoperative analgesia following major pelvic surgery thus minimizing the potentially deleterious effects on blood pressure.…”

Section: Discussionmentioning

confidence: 99%

“…Liu et al have shown that an infusion of epidural bupivacaine and morphine is associated with a shorter duration of postoperative ileus. 1 On the other hand, Thoren et al have shown that epidural morphine prolongs postoperative ileus. 2,3 Morphine, because of its ionized hydrophilic nature, undergoes slower elimination from the neural axis, spreads more rostrally, and has a tendency to produce more side-effects than does fentanyl.…”

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confidence: 99%

Improved bowel function after gynecological surgery with epidural bupivacaine-fentanyl than bupivacaine-morphine infusion

Vallejo

Edwards

Shannon

et al. 2000

Can J Anesth/J Can Anesth

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Methods: In a blinded, randomized, prospective trial, 60 women undergoing surgery for gynecologic cancer were studied. Anesthesia was provided by a combined general/epidural (L 2-3 catheter) technique without epidural opioids. Postoperative epidural analgesia was by continuous infusion of bupivacaine 0.1% with either morphine 0.05mg·ml -1 (BM) or fentanyl 5 µg·ml -1 (BF). Visual Analogue Scale (VAS) scores for pain at rest and during movement, and the return of bowel function were collected for three days and the duration of hospitalization were noted.Results: On POD-1, 18.5% of patients in the BM group had emesis compared with none in the BF group (P = 0.038) and fewer patients in the BM group tolerated clear oral fluids (11.1% BM vs 40.6% BF, P = 0.025). These differences became insignificant on POD-2 and 3. Median pain scores were comparable at rest and ranged from 10-20 in the BM group vs 0-20 in the BF group over the three days. Similarly, median pain scores with movement respectively ranged from 20-25 and 20-30 in the BF and BM groups. The mean duration of hospitalization was longer in the BM group (5.7 ± 2.4) vs BF (4.5 ± 1.2 days), P = 0.017. Conclusion:Epidural BM and BF provided equally effective postoperative analgesia at rest and during movement. Compared with BM, epidural BF is associated with less emesis and an increased ability to tolerate oral fluids on POD-1 and an overall shorter hospital stay.Objectif : Comparer la récupération gastro-intestinale postopératoire à la suite d'une perfusion péridurale continue avec bupivacaïne et, fentanyl ou morphine.Méthode : L'étude à l'insu, randomisée et prospective a porté sur 60 femmes qui ont subi l'opération d'un cancer gynécologique. Une technique générale/péridurale combinée (cathéter dans l'espace L 2-3 ) sans opioïdes périduraux a permis l'anesthésie. L'analgésie péridurale postopératoire comprenait une perfusion continue de bupivacaïne à 0,1 % avec, soit 0,05mg·ml -1 de morphine (BM), soit 5µg·ml -1 de fentanyl (BF). On a enregistré pendant 3 jrs les scores de douleur au repos et pendant le mouvement à l'échelle visuelle analogique (EVA), et le retour de la fonction intestinale. La durée de l'hospitalisation a été notée.Résultats : Au jour 1 postopératoire, 18,5 % des patientes du groupe BM avaient des vomissements mais aucune du groupe BF (P = 0,038) et peu de patientes du groupe BM ont toléré les liquides oraux clairs (11,1 % BM vs 40,6 % BF, P = 0,025). Ces différences n'étaient plus significatives aux jours 2 et 3. Les scores moyens de douleur ont été comparables au repos et allaient de 10-20 pour le groupe BM vs 0-20 pour le groupe BF au cours des trois jours. De même, les scores moyens de douleur au mouvement se retrouvaient respectivement de 20-25 et de 20-30 pour les groupes BF et BM. La durée moyenne d'hospitalisation a été plus longue dans le groupe BM (5,7± 2,4) vs le groupe BF (4,5 ± 1,2 jours), P = 0,017.Conclusion : L'analgésie péridurale BM et l'analgésie BF ont fourni un soulagement équivalent de la douleur postopératoire au repos et...

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Mechanisms and Treatment of Postoperative Ileus

Luckey¹

2003

Arch Surg

408

342

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To review the pathogenesis and treatment of postoperative ileus. Data Sources: Data collected for this review were identified from a MEDLINE database search of the Englishlanguage literature. The exact indexing terms were "postoperative ileus," "treatment," "etiology," and "pathophysiology." Previous review articles and pertinent references from those articles were also used. Study Selection: All relevant studies were included. Only articles that were case presentations or that mentioned postoperative ileus in passing were excluded.

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Effects of Perioperative Analgesic Technique on Rate of Recovery after Colon Surgery

Cited by 441 publications

References 43 publications

Patient controllediv analgesia is an acceptable pain management strategy in morbidly obese patients undergoing gastric bypass surgery. A retrospective comparison with epidural analgesia

Patient controllediv analgesia is an acceptable pain management strategy in morbidly obese patients undergoing gastric bypass surgery. A retrospective comparison with epidural analgesia

Improved bowel function after gynecological surgery with epidural bupivacaine-fentanyl than bupivacaine-morphine infusion

Mechanisms and Treatment of Postoperative Ileus

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