Feasibility analysis of loop colostomy closure in patients under local anesthesia

Abstract

PURPOSE: To verify prospectively the practicability of performing loop colostomy closure under local anesthesia and sedation. METHODS: In this study, 21 patients underwent this operation. Lidocaine 2% and bupivacaine 0.5% were utilized. Pain was evaluated during the operation, on the first postoperative day and at hospital discharge. Intraoperative events, postoperative complications and the acceptability of this procedure were analyzed. RESULTS: The mean duration of the operation was 133 minutes (range: 85 to 290 minutes). The mean postoperative hospitalization was four days (range: one to twelve days). No patients died. Complications occurred in two patients (9.4%): abdominal wall hematoma and operative wound infection. With regard to pain severity, scores of less than or equal to three were indicated in the intraoperative evaluation by 80% of the patients (17/21) and on the first postoperative day by 85% (18/21). At hospital discharge, 95.2% of the patients (20/21) said they were in favor of the local anesthesia technique. CONCLUSION: Loop colostomy closure under local anesthesia and sedation is feasible, safe and acceptable to patients.

Is Radical Bowel Cancer Resection Under Local Anaesthesia and Sedation Feasible?

“…A similar study confirmed the feasibility of closure of loop colostomies under local anaesthesia [5]. There were no identifiable reports of colonic resections under local anaesthesia in the literature, although spinal anaesthesia has been used for colonic resections in a larger number of high-risk patients [6].…”

Randomized clinical trial comparing spinal anesthesia with local anesthesia with sedation for loop colostomy closure

“…The quantity of lidocaine infiltrated ranged from 300 to 600 mg and the quantity of bupivacaine ranged from 50 to 100 mg. With regard to local complications, there was local pain and synthesis difficulty in three patients (3/25) in the SA group, while there were no cases in the group under LA plus sedation (P = 0.234). Systemic complications occurred in four patients (4/25) under SA: nausea (2), vomiting (1) and psychomotor agitation (1). Under LA, such complications occurred in two patients (2/25), nausea (1) and psychomotor agitation (1) (P = 0.667).…”

“…Abreu et al (1) did not need to use opioids postoperatively in their series, but Haagmans et al (5) used opioids in two patients. Reestablishment of intestinal peristaltism was faster in the LA group, as measured by the return of water-air noises, elimination of gases and feces.…”

“…Interventions taking more than 120 minutes have been found to be a factor that increases the morbidity of the operation (17) . In the group under LA, the same anesthesia solution as described by Abreu et al (1) was utilized, without the need to administer larger doses. Cantele et al (2) used 1% lidocaine for loop colostomy closure under LA, while Haagmans et al (5) used lidocaine and prilocaine for loop ileostomy closure.…”

“…A review of the literature showed that two studies have been conducted on loop colostomy closure using local anesthesia (1,2) . They showed that there were many advantages over general and spinal block anesthesia: it involves a limited area of the body; there is little interference with the physiology of other organs; there is no alteration in the patient's respiratory function; intraoperative hydration is achieved more simply; the immediate postoperative period is free of pain; and local anesthesia is well tolerated by high-risk patients.…”