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Epidural analgesia vs systemic opioids in patients undergoing laparoscopic colorectal surgery

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

A well-controlled pain is one of the most important targets of enhanced recovery after surgery (ERAS) protocols. Recent studies questioned the role of TEA (thoracic epidural analgesia) in support of less invasive techniques, in particular in laparoscopic mini-invasive surgery. The aim of this study is to compare patients undergoing laparoscopic mini-invasive colorectal surgery and receiving different analgesic techniques.

Methods

Prospectively collected data entered in the electronic registry of POIS (Perioperative Italian Society) specifically designed for ERAS were reviewed. Patients undergoing colorectal laparoscopic surgery were divided in two groups according to TEA or parenteral opioid administration. In comparing TEA and opioid groups, propensity score weights were obtained. Postoperative pain control and time to readiness for discharge (TRD) were considered as primary endpoints of the study. Secondary endpoints were postoperative morbidity, PONV (postoperative nausea and vomiting), hours of mobilization, length of hospital stay (LOS), timing of fluid and solid re-assumption, and recovery of bowel function.

Results

Fourteen Italian hospitals reported data on 560 patients (283 TEA, 277 opioid group). Patients of the opioid group were able to mobilize for a longer period than TEA group patients but presented a higher incidence of PONV. Pain intensity and TRD were similar in both groups. LOS was significantly reduced in TEA patients; also, this result was clinically irrelevant (5.7 ± 3.21 days TEA group vs 5.8 ± 2.92 opioid group).

Conclusion

In patients undergoing laparoscopic colorectal surgery, TEA was not associated to a better pain control or to an improvement in postoperative outcome compared with opioid administration.

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Authors and Affiliations

  1. Department of Anesthesiology, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy

    Stefano Turi & Luigi Beretta

  2. Anesthesia and Intensive Care Unit-Fatebenefratelli Hospital, Piazzale Principessa Clotilde, 20121, Milano, Italy

    Marco Gemma

  3. Department of Surgery-San Gerardo Hospital, Milano-Bicocca University, Milano, Italy

    Marco Braga

  4. Department of Anesthesia, Humanitas Research Hospital, Rozzano, Milano, Italy

    Roberta Monzani

  5. Department of Anesthesia, Legnano Hospital, Milan, Italy

    Danilo Radrizzani

Authors
  1. Stefano Turi
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  2. Marco Gemma
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  3. Marco Braga
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  4. Roberta Monzani
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  5. Danilo Radrizzani
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  6. Luigi Beretta
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Consortia

on behalf of the Perioperative Italian Society-ERAS Italian Chapter

Contributions

Marco Scatizzi MD, Felice Borghi MD, Giancarlo Missana MD, Marco Azzola MD, Andrea Muratore MD, Michele Crespi MD, Riccardo Iuliani MD, Carlo Bima MD, Hedayat Bouzari MD, Andrea Pisani Ceretti MD, Luca Pellegrino MD, Marianna Maspero, Umberto Casiraghi, Ferdinando Ficari MD.

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Correspondence to Stefano Turi.

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Turi, S., Gemma, M., Braga, M. et al. Epidural analgesia vs systemic opioids in patients undergoing laparoscopic colorectal surgery. Int J Colorectal Dis 34, 915–921 (2019). https://doi.org/10.1007/s00384-019-03284-4

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  • DOI: https://doi.org/10.1007/s00384-019-03284-4

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