Short-term outcomes with intrathecal <i>versus</i> epidural analgesia in laparoscopic colorectal surgery

Virlos, Ioannis T.; Clements, Debbie; Beynon, J.; Ratnalikar, Vinay; Khot, U

doi:10.1002/bjs.7127

Cited by 70 publications

(48 citation statements)

References 29 publications

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“…Immobility can also prevent enhanced recovery 26. In other retrospective investigations in which ITM shortened hospital stay compared with epidural analgesia, epidural analgesia was also associated with a larger amount of intravascular fluid administration or limited ambulation 3,4. However, our results show that fluid overload and motor blockade during epidural analgesia are avoidable.…”

Section: Discussionmentioning

confidence: 50%

“…Several studies reported that ITM-IVPCA offered similar or even better analgesia compared to patient controlled epidural analgesia in patients undergoing hepato-pancreato-biliary surgery3 or laparoscopic colorectal surgery 4. Furthermore, there were reports that ITM-IVPCA compared to epidural analgesia is associated with a lower or similar incidence of respiratory complication and a better recovery profile such as shorter hospital stay in hepato-pancreato-biliary surgery3 or laparoscopic colorectal surgery 4,5…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of Intrathecal Morphine Combined with Intravenous Analgesia versus Thoracic Epidural Analgesia after Gastrectomy

et al. 2014

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PurposeEpidural analgesia has been the preferred analgesic technique after major abdominal surgery. On the other hand, the combined use of intrathecal morphine (ITM) and intravenous patient controlled analgesia (IVPCA) has been shown to be a viable alternative approach for analgesia. We hypothesized that ITM combined with IVPCA is as effective as patient controlled thoracic epidural analgesia (PCTEA) with respect to postoperative pain control after conventional open gastrectomy.Materials and MethodsSixty-four patients undergoing conventional open gastrectomy due to gastric cancer were randomly allocated into the intrathecal morphine combined with intravenous patient-controlled analgesia (IT) group or patient-controlled thoracic epidural analgesia (EP) group. The IT group received preoperative 0.3 mg of ITM, followed by postoperative IVPCA. The EP group preoperatively underwent epidural catheterization, followed by postoperative PCTEA. Visual analog scale (VAS) scores were assessed until 48 hrs after surgery. Adverse effects related to analgesia, profiles associated with recovery from surgery, and postoperative complications within 30 days after surgery were also evaluated.ResultsThis study failed to demonstrate the non-inferiority of ITM-IVPCA (n=29) to PCTEA (n=30) with respect to VAS 24 hrs after surgery. Furthermore, the IT group consumed more fentanyl than the EP group did (1247.2±263.7 µg vs. 1048.9±71.7 µg, p<0.001). The IT group took a longer time to ambulate than the EP group (p=0.021) and had higher incidences of postoperative ileus (p=0.012) and pulmonary complications (p=0.05) compared with the EP group.ConclusionITM-IVPCA is not as effective as PCTEA in patients undergoing gastrectomy, with respect to pain control, ambulation, postoperative ileus and pulmonary complications.

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Section: Discussionmentioning

confidence: 50%

Section: Introductionmentioning

confidence: 99%

Efficacy of Intrathecal Morphine Combined with Intravenous Analgesia versus Thoracic Epidural Analgesia after Gastrectomy

et al. 2014

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“…11 12 However, applying the same analgesic principles in the laparoscopic setting has not produced the same results in this cohort of patients, with reports of longer length of stay and delayed return of gastrointestinal function associated with the use of epidural analgesia. [13][14][15] This has led to a number of alternative analgesic strategies being employed in laparoscopic colorectal surgery, including the use of spinal analgesia, [15][16][17][18][19] patient-controlled analgesia (PCA), [20][21][22] subcutaneous and/or intraperitoneal local anaesthetics, local anaesthetic wound infiltration catheters 23 24 and transversus abdominis plane (TAP) blocks. [25][26][27][28] There have been a number of cohort studies and randomised controlled trials comparing different analgesic modalities with encouraging results; however, these studies are often single-armed or double-armed studies, comparing only one or two analgesic modalities.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Protocol for a multicentre, prospective, observational cohort study of variation in practice in perioperative analgesic strategies in elective laparoscopic colorectal surgery: the LapCoGesic Study

Burnell¹,

Coates²,

Dixon³

et al. 2016

BMJ Open

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IntroductionLaparoscopic surgery combined with enhanced recovery programmes has become the gold standard in the elective management of colorectal disease. However, there is no consensus with regard to the optimal perioperative analgesic regime in this cohort of patients, with a number of options available, including thoracic epidural spinal analgesia, patient-controlled analgesia, subcutaneous and/or intraperitoneal local anaesthetics, local anaesthetic wound infiltration catheters and transversus abdominis plane blocks. This study aims to explore any differences in analgesic strategies employed across the North East of England and to assess whether any variation in practice has an impact on clinical outcomes.Methods and analysisAll North East Colorectal units will be recruited for participation by the Northern Surgical Trainees Research Association (NoSTRA). Data will be collected over a consecutive 2-month period. Outcome measures will include postoperative pain score, postoperative opioid analgesic use and side effects, length of stay, 30-day complication rates, 30-day reoperative rates and 30-day readmission rates.Ethics and disseminationEthical approval for this study has been granted by the National Research Ethics Service. The protocol will be disseminated through NoSTRA. Individual unit data will be presented at local meetings. Overall collective data will be published in peer-reviewed journals and presented at relevant surgical meetings.

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“…28,29 This is of particular interest as this modality has been shown to reduce postoperative pain and opioid requirements although not secondary functional outcomes such as mobility, gut function and opioid side effects. 41 By contrast, seven other RCTs found significant opioid sparing effects (ranging from 33% to 77%). 22,23,25,[31][32][33][34] Two meta-analyses have been performed.…”

Section: Addition Of Transversus Abdominis Plane Block To Patient Conmentioning

confidence: 95%

Addition of transversus abdominis plane block to patient controlled analgesia for laparoscopic high anterior resection improves analgesia, reduces opioid requirement and expedites recovery of bowel function

Ris

Findlay

Hompes

et al. 2014

annals

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INTRODUCTION Opioid sparing in postoperative pain management appears key in colorectal enhanced recovery. Transversus abdominis plane (TAP) blocks offer such an effect. This study aimed to quantify this effect on pain, opioid use and recovery of bowel function after laparoscopic high anterior resection. METHODS This was a retrospective analysis of prospective data on 68 patients. Patients received an epidural (n=24), intravenous morphine patient controlled analgesia (PCA, n=22) or TAP blocks plus PCA (n=22) determined by anaesthetist preference. Outcome measures were numerical pain scores (0-3), cumulative intravenous morphine dose and time to recovery of bowel function (passage of flatus or stool). RESULTS There were no differences in patient characteristics, complications or extraction site. The TAP block group had lower pain scores (0.7 vs 1.36, p<0.001) and morphine requirements (8mg vs 15mg, p=0.01) than the group receiving PCA alone at 12 hours and 24 hours. Earlier passage of flatus (2.0 vs 2.7 vs 3.4 days, p=0.002), stool (3.1 vs 4.1 vs 5.5 days, p=0.04) and earlier discharge (4 vs 5 vs 6 days, p=0.02) were also seen. CONCLUSIONS Use of TAP blocks was found to reduce pain and morphine use compared with PCA, expedite recovery of bowel function compared with PCA and epidural, and expedite hospital discharge compared with epidural.

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Short-term outcomes with intrathecal versus epidural analgesia in laparoscopic colorectal surgery

Abstract: Intrathecal analgesia may have advantages over epidural analgesia in patients undergoing laparoscopic colorectal surgery.

Cited by 70 publications

References 29 publications

Efficacy of Intrathecal Morphine Combined with Intravenous Analgesia versus Thoracic Epidural Analgesia after Gastrectomy

Efficacy of Intrathecal Morphine Combined with Intravenous Analgesia versus Thoracic Epidural Analgesia after Gastrectomy

Protocol for a multicentre, prospective, observational cohort study of variation in practice in perioperative analgesic strategies in elective laparoscopic colorectal surgery: the LapCoGesic Study

Addition of transversus abdominis plane block to patient controlled analgesia for laparoscopic high anterior resection improves analgesia, reduces opioid requirement and expedites recovery of bowel function

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