Skip to main content

Advertisement

SpringerLink
Log in

Negligible Effect of Perioperative Epidural Analgesia Among Patients Undergoing Elective Gastric and Pancreatic Resections

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

There are conflicting data regarding improvements in postoperative outcomes with perioperative epidural analgesia. We sought to examine the effect of perioperative epidural analgesia vs. intravenous narcotic analgesia on perioperative outcomes including pain control, morbidity, and mortality in patients undergoing gastric and pancreatic resections.

Methods

We evaluated 169 patients from 2007 to 2011 who underwent open gastric and pancreatic resections for malignancy at a university medical center. Emergency, traumatic, pediatric, enucleations, and disseminated cancer cases were excluded. Clinicopathologic data were reviewed among epidural (E) and non-epidural (NE) patients for their association with perioperative endpoints.

Results

One hundred twenty patients (71 %) received an epidural and 49 (29 %) did not. There were no significant differences (P > 0.05) in mean pain scores at each of the four days (days 0–3) among the E (3.2 ± 2.7, 3.2 ± 2.3, 2.3 ± 1.9, and 2.1 ± 1.9, respectively) and NE patients (3.7 ± 2.7, 3.4 ± 1.9, 2.9 ± 2.1, and 2.4 ± 1.9, respectively). Within each of the E and NE patient groups, there were significant differences (P < 0.0001) in mean pain scores from day 0 to day 3 (P < 0.0001). Of the E patients, 69 % also received intravenous patient-controlled analgesia (PCA). Ileus (13 % E vs. 8 % NE), pneumonia (12 % E vs. 8 % NE), venous thromboembolism (6 % E vs. 4 % NE), length of stay [11.0 ± 12.1 (8, 4–107) E vs. 12.2 ± 10.7 (7, 3–54) NE], overall morbidity (36 % E vs. 39 % NE), and mortality (4 % E vs. 2 % NE) were not significantly different.

Conclusions

Routine use of epidurals in this group of patients does not appear to be superior to PCA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Werawatganon TC, Somrat. Patient Controlled Intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery (Review). The Cochrane Library 2008:19.

  2. Block BML, Spencer S.; Bowlingson, Andrew J.; Cowan, Anne R.; Cowan, John A.; Wu, Christopher L. Efficacy of Postoperative Epidural Analgesia—A Meta-analysis. JAMA 2003;290:9.

    Article  Google Scholar 

  3. Marret E, Remy C, Bonnet F. Meta-analysis of epidural analgesia versus parenteral opioid analgesia after colorectal surgery. Br J Surg 2007;94:665–673.

    Article  PubMed  CAS  Google Scholar 

  4. Jorgensen H, Wetterslev J, Moiniche S, Dahl JB. Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery. Cochrane Database Syst Rev 2000:CD001893.

  5. Popping DM, Elia, N; Marret, Emmanuel; Remy, Camille; Tramer, Martine R. Protective Effects of Epidural Analgesia on Pulmonary Complications after Abdominal and Thoracic Surgery. Archives of Surgery 2008;143:10.

    Article  Google Scholar 

  6. Moselli NM, Baricocchi E, Ribero D, Sottile A, Suita L, Debernardi F. Intraoperative epidural analgesia prevents the early proinflammatory response to surgical trauma. Results from a prospective randomized clinical trial of intraoperative epidural versus general analgesia. Ann Surg Oncol 2011;18:2722–2731.

    Article  PubMed  Google Scholar 

  7. Rigg JRA, Jamrozik K, Myles PS, Silbert BS, Peyton PJ, Parsons RW, Collins KS. Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. The Lancet 2002;359:1276–1282.

    Article  Google Scholar 

  8. Rodgers A, Walker, N; Schug, S; McKee, A.; Kehlet, H.; van Zundert, A.; Sage, D.; Futter, M.; Saville, G.; Clark, T.; MacMahon, S. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. British Medical Journal 2000;321:12.

    Article  Google Scholar 

  9. Bartha E, Carlsson P, Kalman S. Evaluation of costs and effects of epidural analgesia and patient-controlled intravenous analgesia after major abdominal surgery. Br J Anaesth 2006;96:111–117.

    Article  PubMed  CAS  Google Scholar 

  10. Konigsrainer I, Bredanger S, Drewel-Frohnmeyer R, Vonthein R, Krueger WA, Konigsrainer A, Unertl KE, Schroeder TH. Audit of motor weakness and premature catheter dislodgement after epidural analgesia in major abdominal surgery. Anaesthesia 2009;64:27–31.

    Article  PubMed  CAS  Google Scholar 

  11. Grobmyer SR, Pieracci FM, Allen PJ, Brennan MF, Jaques DP. Defining morbidity after pancreaticoduodenectomy: use of a prospective complication grading system. J Am Coll Surg 2007;204:356–364.

    Article  PubMed  Google Scholar 

  12. Niederman MS, Craven DE for the American Thoracic Society Board of Directors and the Infectious Disease Society of America Guideline Committee. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388–416.

    Google Scholar 

  13. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138:8–13.

    Article  PubMed  Google Scholar 

  14. Balcom JH, Rattner DW, Warshaw AL, Chang Y, Fernandez-del Castillo C. Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch Surg 2001;136:391–398.

    Article  PubMed  Google Scholar 

  15. Park WYT, Jon S.; Lee, Kelvin K. Effect of Epidural Anesthesia and Analgesia on Perioperative Outcome—A Randomized, Controlled Veterans Affairs Cooperative Study. Annals of Surgery 2001;234:12.

    Google Scholar 

  16. Zutshi M, Delaney CP, Senagore AJ, Mekhail N, Lewis B, Connor JT, Fazio VW. Randomized controlled trial comparing the controlled rehabilitation with early ambulation and diet pathway versus the controlled rehabilitation with early ambulation and diet with preemptive epidural anesthesia/analgesia after laparotomy and intestinal resection. Am J Surg 2005;189:268–272.

    Article  PubMed  Google Scholar 

  17. Turunen P, Carpelan-Holmstrom M, Kairaluoma P, Wikstrom H, Kruuna O, Pere P, Bachmann M, Sarna S, Scheinin T. Epidural analgesia diminished pain but did not otherwise improve enhanced recovery after laparoscopic sigmoidectomy: a prospective randomized study. Surg Endosc 2009;23:31–37.

    Article  PubMed  Google Scholar 

  18. Gendall KA, Kennedy RR, Watson AJM, Frizelle FA. The effect of epidural analgesia on postoperative outcome after colorectal surgery. Colorectal Disease 2007;9:584–598.

    Article  PubMed  CAS  Google Scholar 

  19. Duncan F. Prospective observational study of postoperative epidural analgesia for major abdominal surgery. J Clin Nurs 2011;20:1870–1879.

    Article  PubMed  Google Scholar 

  20. Seiler CM, Deckert A, Diener MK, Knaebel HP, Weigand MA, Victor N, Buchler MW. Midline versus transverse incision in major abdominal surgery: a randomized, double-blind equivalence trial (POVATI: ISRCTN60734227). Ann Surg 2009;249:913–920.

    Article  PubMed  Google Scholar 

  21. Brown, S. R., and Goodfellow, P. B. Transverse verses midline incisions for abdominal surgery. Cochrane Database Syst Rev 19:CD005199, 2005.

    Google Scholar 

Download references

Acknowledgments

Statistical services are supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant no. UL1 TR000002.

Author information

Authors and Affiliations

  1. Division of Surgical Oncology, UC Davis Cancer Center, 4501 X Street, Sacramento, CA, 95817, USA

    Dhruvil R. Shah, Erin Brown, Jack E. Russo, Steve R. Martinez, Jodi M. Coates, Richard J. Bold & Robert J. Canter

  2. Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA, 95616, USA

    Chin-Shang Li

Authors
  1. Dhruvil R. Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Erin Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jack E. Russo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chin-Shang Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Steve R. Martinez
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jodi M. Coates
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Richard J. Bold
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Robert J. Canter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert J. Canter.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shah, D.R., Brown, E., Russo, J.E. et al. Negligible Effect of Perioperative Epidural Analgesia Among Patients Undergoing Elective Gastric and Pancreatic Resections. J Gastrointest Surg 17, 660–667 (2013). https://doi.org/10.1007/s11605-013-2142-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-013-2142-4

Keywords

Search

Navigation