Skip to main content

Advertisement

Log in

The effect of intraoperative thoracic epidural anesthesia and postoperative analgesia on bowel function after colorectal surgery

A prospective, randomized trial

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: Colorectal surgery is associated with postoperative ileus, which contributes to delayed discharge. This study was designed to investigate the effect of thoracic epidural anesthesia and analgesia on gastrointestinal function after colorectal surgery under standardized controlled postoperative care. METHODS: Forty-two patients diagnosed with either colonic cancer, diverticulitis, polyps, or adenoma, and scheduled for elective colorectal surgery, were randomly assigned to either postoperative patient-controlled analgesia (PCA) with intravenous morphine (n=21) or epidural analgesia with a mixture of bupivacaine and fentanyl (n=21). Postoperative early oral feeding and assistance to mobilization were offered to all patients. Pain visual analog scale (1–100 mm), passage of flatus and bowel movements, length of hospital stay, and readiness for discharge were recorded. RESULTS: Pain visual analog scale (visual analog scale, 1–100 mm) at rest, on coughing, and daily on mobilization was significantly lower in the epidural group compared with the patient-controlled analgesia group. Median values for the visual analog scale group were 7 (95 percent confidence interval, 2–18) mm, 19 (95 percent confidence interval, 4–38) mm, and 10 (95 percent confidence interval, 5–33) mm, respectively, and, for the patient-controlled analgesia group, were 24 (95 percent confidence interval, 18–51) mm, 59 (95 percent confidence interval, 33–74) mm, and 40 (95 percent confidence interval, 29–79) mm, respectively (P<0.01). Intake of protein and calories and time out of bed were similar in both groups. Mean time intervals ± standard deviation from surgery to first flatus and first bowel movement occurred earlier in the epidural group, 1.9±0.6 days and 3.1±1.7 days, respectively, compared with patient-controlled analgesia, 3.6±1.5 days and 4.6 ± 1.6 days, respectively (P<0.01). Postoperative complications occurred in 33 percent of the patient-controlled analgesia group and 28 percent of the epidural group. There was no significant difference in length of hospital stay between the two groups with a mean of 7.3±3.7 days in the patient-controlled analgesia group and 8.5±4.2 days in the epidural group. Readiness for discharge was similar in both groups. CONCLUSION: Thoracic epidural analgesia has distinct advantages over patient-controlled analgesia morphine in providing superior quality of analgesia and shortening the duration of postoperative ileus. However, discharge home was not faster, indicating that other perioperative factors influence the length of hospital stay.

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

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Livingston EH, Passaro EP. Postoperative ileus. Dig Dis Sci 1990;35:121–32.

    Google Scholar 

  2. Graber JN, Schulte J, Condon RE. Relationship of duration of postoperative ileus to extent and site of operative dissection. Surgery 1982;92:87–92.

    Google Scholar 

  3. Wattwil M, Thoren T, Hennerdal S, Garvil JE. Epidural analgesia with bupivacaine reduces postoperative paralytic ileus after hysterectomy. Anesth Analg 1989;68:353–8.

    Google Scholar 

  4. Liu SS, Carpenter RL, Mackey DC. Effect of perioperative analgesic technique on rate of recovery after colon surgery. Anesthesiology 1995;83:757–65.

    Google Scholar 

  5. Brendtmann RD, Herden HN, Teichmann W, Moecke HP, Kniesel B, Baegten R. Epidural analgesia in colonic surgery: results of a randomized prospective study. Br J Surg 1990;77:763–4.

    Google Scholar 

  6. Mann C, Pouzeratte Y, Boccara G,et al. Comparison of intravenous or epidural patient-controlled analgesia in the elderly after major abdominal surgery. Anesthesiology 2000;92:433–41.

    Google Scholar 

  7. Hjortso NC, Neumann P, Froig F,et al. A controlled study on the effect of epidural analgesia with local anesthetics and morphine on morbidity after abdominal surgery. Acta Anaesthesiol Scand 1985;29:790–6.

    Google Scholar 

  8. Wallin G, Cassuto J, Hogstrom R, Rimback G, Faxen A, Tollesson PO. Failure of epidural anesthesia to prevent postoperative paralytic ileus. Anesthesiology 1986;65:292–7.

    Google Scholar 

  9. Neudecker J, Schwenk W, Junghans T,et al. Randomized controlled trial to examine the influence of thoracic epidural analgesia on postoperative ileus after laparoscopic sigmoid resection. Br J Surg 1999;86:1292–5.

    Google Scholar 

  10. Ahn H, Bronge A, Johansson K,et al. Effect of continuous postoperative epidural analgesia on intestinal motility. Br J Surg 1988;75:1176–8.

    Google Scholar 

  11. Scheinin B, Asantila R, Orko R. The effect of bupivacaine and morphine on pain and bowel function after colonic surgery. Acta Anaesthesiol Scand 1987;31:161–4.

    Google Scholar 

  12. Hodgson PS, Liu S. Thoracic epidural anaesthesia and analgesia for abdominal surgery: effects on gastrointestinal function and perfusion. Baillieres Clin Anaesthesiol 1999;13:9–22.

    Google Scholar 

  13. Johansson K, Ahn H, Lindhagen J, Tryselius U. Effect of epidural anaesthesia on intestinal blood flow. Br J Surg 1988;75:73–6.

    Google Scholar 

  14. Yudioka H, Bogod DG, Rosen M. Recovery of bowel motility after surgery. Br J Anaesth 1987;59:581–4.

    Google Scholar 

  15. Scott AM, Starling JR, Ruscher AE. Thoracic versus lumbar epidural anesthesia's effect on pain control and ileus resolution after restorative proctocolectomy. Surgery 1996;120:688–97.

    Google Scholar 

  16. Bisgaard C, Mourisden P, Dahl JB. Continuous lumbar epidural bupivacaine plus morphine versus epidural morphine after major abdominal surgery. Eur J Anaesthesiol 1990;7:219–25.

    Google Scholar 

  17. Carli F, Schricker T. Combined epidural/general anesthesia for gastrointestinal surgery. Techniques Reg Anesth Pain Manage 2000;4:2:1–7.

    Google Scholar 

  18. Reissman P, Teoh TA, Cohen SM. Is early oral feeding safe after elective colorectal surgery? Ann Surg 1995;221:327–8.

    Google Scholar 

  19. Stewart BT, Woods RJ, Collopy BT, Fink RJ, Mackay JR, Keck JO. Early feeding after elective open colorectal resections: A prospective randomized trial. Aust N Z J Surg 1998;68:125–8.

    Google Scholar 

  20. DiFronzo LA, Cymerman J, O'Connell TX. Factors affecting early postoperative feeding following elective open colon resection. Arch Surg 1999;34:941–6.

    Google Scholar 

  21. Simpson K, Kilian K, McCartney NM, Stubbing DG, Jones NL. Randomized controlled trial of weightlifting exercise in patients with chronic airflow limitation. Thorax 1992;47:70–5.

    Google Scholar 

  22. McCartney N, McKelvie RS, Haslam DR, Jones NL. Usefulness of weightlifting training in improving strength and maximal power output in coronary artery disease. Am J Cardiol 1191;67:939–45.

    Google Scholar 

  23. Bradshaw BG, Liu S, Thirlby RC. Standardized perioperative care protocols and reduced length of stay after colon surgery. J Am Coll Surg 1998;186:501–6.

    Google Scholar 

  24. Basse L, Hjort Jakobsen D, Billesbolle P, Werner M, Kehlet H. A clinical pathway to accelerate recovery after colonic resection. Ann Surg 2000;232:51–7.

    Google Scholar 

  25. Kehlet H, Moesgaard F. Prophylaxis against postoperative complications in gastroenterology. Scand J Gastroenterol Suppl 1996;31:218–24.

    Google Scholar 

  26. Kehlet H, Mogensen T. Hospital stay of 2 days after open sigmoidectomy with a multimodal rehabilitation programme. Br J Surg 1999;86:227–30.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

Supported by the Royal Victoria Hospital Research Institute and by research funds from the Departments of Anesthesia and Surgery, McGill University Health Centre.

About this article

Cite this article

Carli, F., Trudel, J.L. & Belliveau, P. The effect of intraoperative thoracic epidural anesthesia and postoperative analgesia on bowel function after colorectal surgery. Dis Colon Rectum 44, 1083–1089 (2001). https://doi.org/10.1007/BF02234626

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02234626

Key words

Navigation