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Surgical Endoscopy

, Volume 21, Issue 2, pp 247–252 | Cite as

Thoracic epidural analgesia facilitates the restoration of bowel function and dietary intake in patients undergoing laparoscopic colon resection using a traditional, nonaccelerated, perioperative care program

  • A. Taqi
  • X. Hong
  • G. Mistraletti
  • B. Stein
  • P. Charlebois
  • F. CarliEmail author
Article

Abstract

Background

This randomized trial compared thoracic epidural analgesia with patient-controlled analgesia (PCA) using morphine for laparoscopic colectomy in a traditional, nonaccelerated, perioperative care program.

Methods

In the study, 50 patients scheduled for elective laparoscopic colon resection were randomized to either PCA morphine (n = 25) or thoracic epidural analgesia with bupivacaine and fentanyl (n = 25). Both groups received general anesthesia and multimodal pain relief, which included naproxen and acetaminophen for as long as 4 postoperative days. Time until passage of gas and bowel movements, dietary intake, postoperative quality of analgesia, readiness for discharge, and length of hospital stay were recorded.

Results

Recovery of postoperative ileus occurred sooner in the epidural group (p < 0.005) by an average 1 to 2 days, and resumption of full diet was achieved earlier (p < 0.05). Intensity of pain during the first 2 postoperative days was significantly lower at rest, with coughing, and with walking in the epidural group (p < 0.005). Readiness for discharge and hospital length of stay (5 days) were otherwise similar in the two groups.

Conclusions

When a traditional perioperative care program is used for laparoscopic colectomy, thoracic epidural analgesia is superior to PCA in accelerating the return of bowel function and dietary intake, while providing better pain relief.

Keywords

Laparoscopic colectomy Patient-controlled analgesia Perioperative care program Thoracic epidural analgesia 

Notes

Acknowledgments

Dr. X. Hong was awarded a fellowship from the McGill University Health Centre (MUHC) Foundation. Dr. G. Mistraletti was the recipient of a scholarship from the University of Milan and the Societa’ Italiana di Anestesia, Rianimazione e Terapia Intensiva (SIARTI). An operating grant for this project was provided by the MUHC Research Institute to Dr. F Carli.

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Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • A. Taqi
    • 1
  • X. Hong
    • 2
  • G. Mistraletti
    • 2
  • B. Stein
    • 1
  • P. Charlebois
    • 1
  • F. Carli
    • 2
    Email author
  1. 1.Department of SurgeryMcGill University Health CentreMontrealCanada
  2. 2.Department of AnesthesiaMcGill University Health CentreMontrealCanada

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