Summary
Background
The role of general anesthesia combined with epidural anesthesia in laparoscopic colorectal surgery is still controversial. In this retrospective study of 84 consecutive patients, the rate of successfully placed epidural catheter and its effect on perioperative pain and outcome are analyzed.
Methods
A total of 84 patients, 36 (43 %) female, with a median (range) age of 64 (19–82) years and a median (range) body mass index of 25 (15–37) kg/m2, were operated; 12 (14 %) procedures were performed via single-incision laparoscopic technique.
Results
The rate of successfully placed epidural anesthesia was 27 % (23), and less postoperative pain (p = 0.04) and need for opioids (p = 0.00) were observed on the day of surgery and first postoperative day. No effect was observed on bowel function, tolerance of solid food, or hospital stay.
Conclusions
In daily surgical laparoscopic practice, the rate of epidural anesthesia is low. Less pain and less need for opioids, but no effect on bowel function or hospital stay, could be demonstrated.
Similar content being viewed by others
References
Kehlet H. Fast-track colorectal surgery. Lancet. 2008;371:791–3.
Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008;248:189–98.
Zingg U, Miskovic D, Hamel CT, Erni L, Oertli D, Metzger U. Influence of thoracic epidural analgesia on postoperative pain relief and ileus after laparoscopic colorectal resection: benefit with epidural analgesia. Surg Endosc. 2009;23(2):276–82.
Chen WK, Ren L, Wei Y, Zhu DX, Miao CH, Xu JM. General anesthesia combined with epidural anesthesia ameliorates the effect of fast-track surgery by mitigating immunosuppression and facilitating intestinal functional recovery in colon cancer patients. Int J Colorectal Dis. In press 2015.
Vlug MS, Bartels SA, Wind J, Ubbink DT, Hollmann MW, Bemelman WA, Collaborative LAFA Study Group. Which fast track elements predict early recovery after colon cancer surgery? Colorectal Dis. 2012;14(8):1001–8.
Levy BF, Scott MJ, Fawcett W, Fry C, Rockall TA. Randomized clinical trial of epidural, spinal or patient-controlled analgesia for patients undergoing laparoscopic colorectal surgery. Br J Surg. 2011;98(8):1068–78.
van de Velde CJ, et al. Experts reviews of the multidisciplinary consensus conference colon and rectal cancer 2012: science, opinions and experiences from the experts of surgery. Eur J Surg Oncol. 2014;40(4):454–68.
Liu H, Hu X, Duan X, Wu J. Thoracic epidural analgesia (TEA) vs. patient controlled analgesia (PCA) in laparoscopic colectomy: a meta-analysis. Hepatogastroenterology. 2014;61(133):1213–9.
Wongyingsinn M, Baldini G, Charlebois P, Liberman S, Stein B, Carli F. Intravenous lidocaine versus thoracic epidural analgesia: a randomized controlled trial in patients undergoing laparoscopic colorectal surgery using an enhanced recovery program. Reg Anesth Pain Med. 2011;36(3):241–8.
Hermanides J, Hollmann MW, Stevens MF, Lirk P. Failed epidural: causes and management. Br J Anaesth. 2012;109(2):144–54.
Konigsrainer I, Bredanger S, Drewel-Frohnmeyer R, et al. Audit of motor weakness and premature catheter dislodgement after epidural analgesia in major abdominal surgery. Anaesthesia. 2009;64:27–31.
Khan SA, Khokhar HA, Nasr AR, Carton E, El-Masry S. Effect of epidural analgesia on bowel function in laparoscopic colorectal surgery: a systematic review and meta-analysis. Surg Endosc. 2013;27(7):2581–91.
Hu Y, Craig SJ, Rowlingson JC, Morton SP, Thomas CJ, Persinger MB, Isbell J, Lau CL, Kozower BD. Early removal of urinary catheter after surgery requiring thoracic epidural: a prospective trial. J Cardiothorac Vasc Anesth. 2014;28(5):1302–6.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Anschütz, M., Drautz, J. & Kafka-Ritsch, R. Effect of perioperative epidural anesthesia in elective laparoscopic colorectal resections. Eur Surg 47, 53–55 (2015). https://doi.org/10.1007/s10353-015-0302-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10353-015-0302-3