Epidural Local Anesthetics Versus Opioid-Based Analgesic Regimens for Postoperative Gastrointestinal Paralysis, Vomiting, and Pain After Abdominal Surgery

Abstract

An epidural containing a local anesthetic, with or without the addition of an opioid, accelerates the return of the gastrointestinal transit (high quality of evidence). An epidural containing a local anesthetic with an opioid decreases pain after an abdominal surgery (moderate quality of evidence). An epidural containing a local anesthetic does not affect the incidence of vomiting or anastomotic leak (low quality of evidence). For an open surgery, an epidural containing a local anesthetic would reduce the length of hospital stay (very low quality of evidence).

mprovement of recovery parameters using patient-controlled epidural analgesia after oncological surgery. A prospective, randomized single center study

“…PCEA analgesia is an important tool of anaesthetists assuring a good pain control, a decrease of several postoperative complications and thus improving safety and early well-being of the patients after surgery [25,26]. Our finding of improved postoperative pain scores by PCEA is in concordance with previous reports in pelvis and abdominal surgery [3,6,7,10,11,15,24,26,27]. We noticed a significantly prolonged surgery time in the PCEA group.…”

“…Prolonged postoperative ileus is associated with prolonged hospitalization and increased costs [7,23,24,29]. The time to first postoperative flatus and stool commonly defines the gastrointestinal function recovery post-surgery and is generally chosen as an outcome measure in clinical studies assessing rehabilitation after surgery [6,29]. We demonstrated the effectiveness of epidural analgesia on the early returning of gastrointestinal transit after major open laparotomy.…”

“…Consequently, an optimal pain control is mandatory after surgery. The studies reported that epidural analgesia is superior to intravenous opioid analgesia in patients undergoing major thoracic, abdominal and pelvic surgery, including colorectal and gastric cancer surgery [3,6,7,10,11,13,15,24]. PCA is an effective and safe method for pain relief after major, open, abdominal surgery [10-15, 24, 25].…”

“…The majority of studies founded similar results. Guay et al concluded that epidural analgesia accelerates the recovery of gastrointestinal transit after open abdominal surgery [6]. Also, Carli et al founded that thoracic epidural analgesia shortens the duration of postoperative ileus after colorectal surgery as compared with PCA with IV morphine [30].…”

“…Surgery represents the cornerstone in the management of solid malignant tumors but it is associated with high incidence of postoperative complaints and complications [2][3][4]. Acute postoperative pain, nausea and vomiting, delay in gastrointestinal motility and mobilization have all been associated with reduced early postoperative well-being and prolonged hospitalization [5][6][7]. The provision of good symptom relief following gastrointestinal cancer surgery is important for limiting morbidity and mortality [8,9].…”