Laparoscopic rectal resection without epidural catheters—does it work?

Abstract

Purpose: Placement of an epidural catheter (EC) in colorectal resections is still recommended as a valid measure to achieve a low level of pain. However, EC is associated with increased invasiveness, and with an increased risk of bladder emptying disorders and a decrease of blood pressure, which all relate to delayed mobilization. Preliminary data show that EC placement may not be necessary in laparoscopic colon resections. The aim of this prospective study was to investigate how omission of EC placement in uences short-term postoperative outcomes in laparoscopic rectal resections.Methods: All laparoscopic rectal resections occurring between 2013-2020 were prospectively examined. Resections from 01/2013-02/2018 (group A) were compared with resections from 03/2018-12/2020 (group B; after internal change of the perioperative pain regime). In addition to EC placement, the other target parameters of our study were urinary catheter placement during the inpatient stay, postoperative pain >3 days on a numerical rating scale (NRS), mobilization in the rst 5 postoperative days, time until the rst postoperative bowel movement, postoperative complications according to Clavien-Dindo, Intermediate care unit stay (IMC stay) in days and hospital length of stay in days.Results: In the entire study period, 221 laparoscopic rectal resections were performed: 122 in group A, and 99 resections in group B. The frequency of EC placement and urinary catheter placement, postoperative IMC stay, and hospital length of stay, were signi cantly lower in group B (p<0.05). The postoperative mobilization of patients in group B was possible more quickly. There were no differences in the level of pain, time until the rst postoperative bowel movement, and postoperative complications according to Clavien-Dindo.Conclusion: Omission of EC placement in laparoscopic rectal resections led to faster mobilization, a shorter IMC stay, and a shorter hospital stay without increasing the pain level. Postoperative complications did not change when an EC was not placed. Therefore, routine EC placement in laparoscopic rectal resections is unnecessary.