Epidural versus  Continuous Preperitoneal Analgesia during Fast-track Open Colorectal Surgery

Abstract

Background: Effective postoperative analgesia is essential for early rehabilitation after surgery. Continuous wound infiltration (CWI) of local anesthetics has been proposed as an alternative to epidural analgesia (EA) during colorectal surgery. This prospective, double-blind trial compared CWI and EA in patients undergoing elective open colorectal surgery. Methods: Fifty consecutive patients were randomized to receive EA or CWI for 48 h. In both groups, patients were managed according to Enhanced Recovery After Surgery recommendations. The primary outcome was the dynamic pain score measured during mobilization 24 h after surgery (H24) using a 100-mm verbal numerical scale. Secondary outcomes were time to functional recovery, analgesic technique-related side effects, and length of hospital stay. Results: Median postoperative dynamic pain score was lower in the EA than in the CWI group (10 [interquartile range: 1.6-20] vs. 37 [interquartile range: 30-49], P < 0.001) and remained lower until hospital discharge. The median times to return of gut function and tolerance of a normal, complete diet were shorter in the EA than in the CWI group (P < 0.01 each). Sleep quality was also better in the EA group, but there was no difference in urinary retention rate (P = 0.57). The median length of stay was lower in the EA than in the CWI group (4 [interquartile range: 3.4-5.3] days vs. 5.5 [interquartile range: 4.5-7] days; P = 0.006). Conclusion:Within an Enhanced Recovery After Surgery program, EA provided quicker functional recovery than CWI and reduced length of hospital stay after open colorectal surgery.

Four quadrant transversus abdominis plane block and continuous transversus abdominis plane analgesia: a 3-year prospective audit in 124 patients

“…The last decade has seen the advent of new techniques for providing analgesia after both open and laparoscopic abdominal surgery [1][2][3][4][5][9][10][11]. Epidural analgesia continues to remains the gold standard after elective open surgery in many centres in the UK [12].…”

“…There has been a move away from epidural analgesia that was once considered as the gold standard. New techniques have been described as possible alternatives and includes transversus abdominis plane (TAP) block [1][2][3]. However single shot TAP blocks fail to provide durable analgesia after major abdominal surgery [4,5].…”

Current issues in postoperative pain management

“…Ropivacaine infusion through a preperitoneally placed catheter provided effective analgesia, less PONV and accelerated postoperative recovery. [92][93][94] The technique has been demonstrated to be superior to epidural analgesia in terms of analgesia and reduction of hospital stay. 93,94 For caesarean section, the most appropriate position is subfascial rather than subcutaneous and in this position, WCI was as effective as epidural analgesia 95 or better.…”

Optimal Analgesia During Major Open and Laparoscopic Abdominal Surgery

“…34,35 Results are varied, with Bertoglio and colleagues 34 reporting similar pain scores but less PONV and accelerated return of bowel function and reduced LOS compared with the epidural group, although these findings were not repeated in a later study by Jouve and colleagues. 35 Concerns of an increased wound infection rate seem to be unsubstantiated.…”