Intestinal effects of thoracic epidural anesthesia

Freise, Hendrik; Fischer, Lars

doi:10.1097/aco.0b013e32832eb7e8

Cited by 35 publications

(14 citation statements)

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“…In cases of unresponsiveness to conservative treatment, surgery is indicated due to the threatening risk of perforation [29, 30] (grade 1D). Usage of a laparoscopic technique with thoracic epidural anaesthesia where appropriate enhances bowel function after abdominal surgery [92–94] (grade 1B), and may therefore prevent bowel dilatation.Feeding protocolsDecreased food intake and resulting malnutrition are independent risk factors for in-hospital mortality [95]. European Society for Parenteral and Enteral Nutrition (ESPEN) guidelines are available with recommendations for nutrition in intensive care [58].…”

Section: Resultsmentioning

confidence: 99%

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Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems

et al. 2012

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PurposeAcute gastrointestinal (GI) dysfunction and failure have been increasingly recognized in critically ill patients. The variety of definitions proposed in the past has led to confusion and difficulty in comparing one study to another. An international working group convened to standardize the definitions for acute GI failure and GI symptoms and to review the therapeutic options.MethodsThe Working Group on Abdominal Problems (WGAP) of the European Society of Intensive Care Medicine (ESICM) developed the definitions for GI dysfunction in intensive care patients on the basis of the available evidence and current understanding of the pathophysiology.ResultsDefinitions for acute gastrointestinal injury (AGI) with its four grades of severity, as well as for feeding intolerance syndrome and GI symptoms (e.g. vomiting, diarrhoea, paralysis, high gastric residual volumes) are proposed. AGI is a malfunctioning of the GI tract in intensive care patients due to their acute illness. AGI grade I = increased risk of developing GI dysfunction or failure (a self-limiting condition); AGI grade II = GI dysfunction (a condition that requires interventions); AGI grade III = GI failure (GI function cannot be restored with interventions); AGI grade IV = dramatically manifesting GI failure (a condition that is immediately life-threatening). Current evidence and expert opinions regarding treatment of acute GI dysfunction are provided.ConclusionsState-of-the-art definitions for GI dysfunction with gradation as well as management recommendations are proposed on the basis of current medical evidence and expert opinion. The WGAP recommends using these definitions for clinical and research purposes.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-011-2459-y) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems

et al. 2012

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“…A good example of the need for procedure-specific studies is the definite positive effects of continuous thoracic epidural analgesia in major open abdominal procedures [12,13,34] to decrease catabolism, ileus, nausea and vomiting and pain, but not necessarily when performing a fast-track laparoscopic colonic resection [35].…”

Section: Pain and Orthostatic Functionmentioning

confidence: 99%

Fast-track surgery—an update on physiological care principles to enhance recovery

Kehlet

2011

Langenbecks Arch Surg

156

109

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“…TEA can be a useful adjunct in fast‐track surgery, optimizing pain relief, freedom from pain attenuating the surgical stress response, the return of early of bowel function, and early mobilization. However, its acceptance among anesthetists remains low and its role remains controversial in laparoscopic surgery because few large studies have evaluated the role of TEA in minimally invasive surgeries …”

Section: Introductionmentioning

confidence: 99%

Improvement of recovery parameters using patient‐controlled epidural analgesia for video‐assisted thoracoscopic surgery lobectomy in enhanced recovery after surgery: A prospective, randomized single center study

et al. 2018

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BackgroundWe compared the effects of thoracic epidural analgesia (TEA) to conventional patient‐controlled analgesia (PCA) on several postoperative parameters of recovery after elective video‐assisted thoracoscopic (VATS) lobectomy.MethodsNinety‐eight patients undergoing elective VATS lobectomy were enrolled. The primary endpoint was pain score. Recovery of bowel function, length of stay in the postanesthesia care unit (PACU), duration of postoperative hospital stay, and complications were assessed. Continuous variables were expressed and compared between groups using either a two‐tailed Student's t or Mann‐Whitney U test. Recovery of bowel function was compared using the log‐rank test.ResultsBaseline characteristics between the groups were similar. Dynamic pain scores on postoperative days (PODs) 0–2 were significantly lower in the TEA group, as were resting pain scores on PODs 1 and 2 (P < 0.05). The mean duration to first flatus (16 ± 0.7 vs. 26 ± 0.7 hours; P < 0.001) and the mean length of stay in the PACU (34 vs. 67 minutes; P = 0.027) were shorter in the TEA compared to the PCA group, respectively. The only difference in postoperative complications was regarding confusion (5 TEA vs. 18 PCA patients; P = 0.002). No difference in overall length of stay was noted.ConclusionsCompared to PCA, TEA provided better postoperative pain control after VATS lobectomy and facilitated postoperative recovery of bowel function without increasing the length of hospital stay. This beneficial effect of TEA might be attributed to the attenuation of sympathetic hyperactivation, improved analgesia, and reduced opioid use.

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Intestinal effects of thoracic epidural anesthesia

Abstract: Further research concerning the use of TEA in major laparoscopic procedures and its potential to improve or endanger anastomotic healing is warranted. The experimental studies of TEA in critical illness should be expanded.

Cited by 35 publications

References 46 publications

Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems

Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems

Fast-track surgery—an update on physiological care principles to enhance recovery

Improvement of recovery parameters using patient‐controlled epidural analgesia for video‐assisted thoracoscopic surgery lobectomy in enhanced recovery after surgery: A prospective, randomized single center study

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