Epidural analgesia in colonic surgery: Results of a randomized prospective study

Abstract

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.

Influence of patient-controlled epidural analgesia versus patient-controlled intravenous analgesia on postoperative pain control and recovery after gastrectomy for gastric cancer: a prospective randomized trial

“…Surgical trauma activates noncholinergic, nonadrenergic spinal reflex mechanisms that block excitatory vagal efferents via bulbar-mediated reflexes [13]. Because of the blocking of this inhibitory reflex when patients use local analgesia with PCEA [14], the combination of an epidural opioid plus bupivacaine may help the recovery of gastrointestinal motility and reduce postoperative ileus [15,16]. A large retrospective study of 726 Chinese patients after cesarean section showed that the time to first flatus passage in women with epidural PCA was 1.33 days, while the time in women who used intravenous PCA was 1.51 days, which means a quicker recovery of gastrointestinal motility with PCEA [17].…”

Effects of epidural analgesia on colonic motility and patients’ outcome in colorectal surgery: a retrospective study

“…Increased splanchnic blood flow may aid anastomotic healing and reduce leakage. Anastomotic leak rates in clinical studies are similar after epidural blockade and general anaesthesia [15][16][17]. For example, a meta-analysis of 562 patients from randomized trials reported between 1966 and 2000 did not detect a significant difference in anastomotic leak between patients receiving either postoperative epidural local anaesthetic or local anaestheticopioid combinations, or those receiving either systemic or epidural opioid [18].…”

“…In some of the studies with epidural catheter placement above T12, gastrointestinal function recovered more rapidly when epidural analgesia was used than when patients received systemic analgesics. Nevertheless, there are some concerns about thoracic epidural analgesia [15]. Studies in which the epidural catheter was positioned at or below T12 were equally as likely to show faster recovery of gastrointestinal function with epidural analgesia as systemic analgesia [16,21].…”

Der postoperative Ileus – pathophysiologische Grundlagen und klinische Aspekte

“…Es gibt mittlerweile zahlreiche klinische Studien, die den positiven Effekt der thorakalen epiduralen Anästhesie mit Lokalanästhetika im Vergleich zur systemischen Opioidgabe auf den POI nachgewiesen haben [58]. Die Effektivität ist jedoch maßgeblich abhän-gig von der hochthorakalen Lage des PDK (Th 6-8) und der kontinuierlichen Verabreichung über 48-72 h postoperativ [59].…”