Surgical Endoscopy

, Volume 23, Issue 1, pp 31–37

Epidural analgesia diminished pain but did not otherwise improve enhanced recovery after laparoscopic sigmoidectomy: a prospective randomized study

  • Pertti Turunen
  • Monika Carpelan-Holmström
  • Pekka Kairaluoma
  • Heidi Wikström
  • Olli Kruuna
  • Pertti Pere
  • Martina Bachmann
  • Seppo Sarna
  • Tom Scheinin
Article

Abstract

Background

The primary hypothesis for this study was that epidural analgesia reduces the use of opioids and thus advances bowel function and oral intake and shortens hospital stay after laparoscopic sigmoidectomy performed according to principles of enhanced recovery after surgery.

Methods

For this study, 60 patients with complicated diverticular disease were randomized to the epidural anesthesia group or the control group before surgery. Postoperative oxycodone consumption, pain, and recovery parameters were followed for 14 days.

Results

The epidural group needed less oxycodone than the control group until 12 h postoperatively. They experienced significantly less pain related to coughing and motion until postoperative day 2. In the epidural group, fewer patients experienced significant pain, and the duration of postoperative pain was shorter. Postoperative oral intake, bowel function, hospital stay, and overall complication rate were similar in the two groups. However, the control group had more postoperative hematomas.

Conclusions

Epidural analgesia significantly alleviates pain, reducing the need for opioids during the first 48 h after laparoscopic sigmoidectomy. However, epidural analgesia does not alter postoperative oral intake, mobilization, or length of hospital stay.

Keywords

Enhanced recovery Epidural analgesia Laparoscopic sigmoidectomy 

References

  1. 1.
    Basse L, Jakobsen DH, Bardram L, Billesbolle P, Lund C, Mogensen T, Rosenberg J, Kehlet H (2005) Functional recovery after open versus laparoscopic colonic resection: a randomized, blinded study. Ann Surg 241:416–423PubMedCrossRefGoogle Scholar
  2. 2.
    Basse L, Raskov HH, Hjort Jakobsen D, Sonne E, Billesbolle P, Hendel HW, Rosenberg J, Kehlet H (2002) Accelerated postoperative recovery programme after colonic resection improves physical performance, pulmonary function and body composition. Br J Surg 89:446–453PubMedCrossRefGoogle Scholar
  3. 3.
    Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CH, Lassen K, Nygren J, Hausel J, Soop M, Andersen J, Kehlet H (2005) Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 24:466–477PubMedCrossRefGoogle Scholar
  4. 4.
    Kehlet H (2005) Procedure-specific postoperative pain management. Anaesthesiol Clin North Am 23:203–210CrossRefGoogle Scholar
  5. 5.
    Kehlet H (1997) Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 78:606–617PubMedGoogle Scholar
  6. 6.
    Jorgensen H, Wetterslev J, Moiniche S, Dahl JB (2000) Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV, and pain after abdominal surgery. Cochrane Database Syst Rev 4:001893Google Scholar
  7. 7.
    Raue W, Haase O, Junghans T, Scharfenberg M, Muller JM, Schwenk W (2004) “Fast-track” multimodal rehabilitation program improves outcome after laparoscopic sigmoidectomy: a controlled prospective evaluation. Surg Endosc 18:1463–1468PubMedCrossRefGoogle Scholar
  8. 8.
    Kehlet H, Buchler MW, Beart RW Jr, Billingham RP, Williamson R (2006) Care after colonic operation: is it evidence-based? Results from a multinational survey in Europe and the United States. J Am Coll Surg 202:45–54PubMedCrossRefGoogle Scholar
  9. 9.
    Kehlet H, Wilmore DW (2005) Fast-track surgery. Br J Surg 92:3–4PubMedCrossRefGoogle Scholar
  10. 10.
    Nygren J, Hausel J, Kehlet H, Revhaug A, Lassen K, Dejong C, Andersen J, von Meyenfeldt M, Ljungqvist O, Fearon KC (2005) A comparison in five European Centres of case mix, clinical management, and outcomes following either conventional or fast-track perioperative care in colorectal surgery. Clin Nutr 24:455–461PubMedCrossRefGoogle Scholar
  11. 11.
    Wind J, Polle SW, Fung Kon Jin PH, Dejong CH, von Meyenfeldt MF, Ubbink DT, Gouma DJ, Bemelman WA (2006) Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg 93:800–809PubMedCrossRefGoogle Scholar
  12. 12.
    Zutshi M, Delaney CP, Senagore AJ, Mekhail N, Lewis B, Connor JT, Zutshi VW (2005) 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 189:268–272PubMedCrossRefGoogle Scholar
  13. 13.
    Rathmell JP, Wu CL, Sinatra RS, Ballantyne JC, Ginsberg B, Gordon DB, Spencer RN, Liu S, Perkins FM, Reuben SS, Rosenqvist RW, Viscusi ER (2006) Acute postsurgical pain management: a critical appraisal of current practice. Regional Anaesth Pain Med 31(4 Suppl 1):1–42CrossRefGoogle Scholar
  14. 14.
    Simpson D, Curran MP, Oldfield V, Keating GM (2005) Ropivacaine: a review of its use in regional anaesthesia and acute pain management. Drugs 65:2675–2717PubMedCrossRefGoogle Scholar
  15. 15.
    Nishimori M, Ballantyne JC, Low JH (2006) Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery. Cochrane Database Syst Rev 3:005059Google Scholar
  16. 16.
    Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioural, and biomedical sciences. Behav Res Methods 39:175–191PubMedGoogle Scholar
  17. 17.
    Kairaluoma PM, Bachmann MS, Korpinen AK, Rosenberg PH, Pere PJ (2004) Single-injection paravertebral block before general anaesthesia enhances analgesia after breast cancer surgery with and without associated lymph node biopsy. Anaesth Analg 99:1837–1843CrossRefGoogle Scholar
  18. 18.
    Richman JM, Rowlingson AJ, Maine DN, Courpas GE, Weller JF, Wu CL (2006) Does neuraxial anaesthesia reduce intraoperative blood loss? A meta-analysis. J Clin Anaesth 18:427–435CrossRefGoogle Scholar
  19. 19.
    Liu SS, Carpenter RL, Mackey DC, Thirlby RC, Rupp SM, Shine TS, Feinglass NG, Metzger PP, Fulmer JT, Smith SL (1995) Effects of perioperative analgesic technique on rate of recovery after colon surgery. Anaesthesiology 83:757–765CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Pertti Turunen
    • 1
  • Monika Carpelan-Holmström
    • 1
  • Pekka Kairaluoma
    • 2
  • Heidi Wikström
    • 1
  • Olli Kruuna
    • 1
  • Pertti Pere
    • 2
  • Martina Bachmann
    • 2
  • Seppo Sarna
    • 3
  • Tom Scheinin
    • 1
  1. 1.Department of Gastroenterological and General SurgeryHelsinki University Central HospitalHelsinkiFinland
  2. 2.Department of Anaesthesia and Intensive Care MedicineHelsinki University Central HospitalHelsinkiFinland
  3. 3.Department of Public HealthUniversity of HelsinkiHelsinkiFinland

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