Skip to main content

Advertisement

Log in

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

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

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.

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. Abraham NS, Young JM, Solomon MJ (2004) Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Br J Surg 91: 1111–1124

    Article  CAS  Google Scholar 

  2. Hildebrabdt U, Kessler K, Plusczyk T, Pistorius C, Vollmar B, Menger MD (2002) Comparison of surgical stress between laparoscopic and open colonic resections. Surg Endosc 17: 242–246

    Article  Google Scholar 

  3. Carli F, Galeone M, Gzodic B, Hong X, Fried GM, Wykes L, Eberhart L, Schricker T (2005) Laparoscopic colon resection improves postoperative glucose utilization without protein-sparing effect. Arch Surg 140: 593–597

    Article  Google Scholar 

  4. Kehlet H (2002) Clinical trials and laparoscopic surgery. Surg Laparosc Endosc 12: 137–138

    Article  Google Scholar 

  5. Wilmore DW, Kehlet H (2001) Management of patients in fast-track surgery. BMJ 322: 473–476

    Article  CAS  Google Scholar 

  6. Basse L, Hjort Jakobsen S, Billesbolle P, Werner M, Kehlet H (2000) A clinical pathway to accelerate recovery after colonic resection. Ann Surg 232: 51–57

    Article  CAS  Google Scholar 

  7. Basse L, Jakobsen DH, Bardram L, Billesbolle P, Lund C, Mogesen T, Rosemberg J, Kehlet H (2005) Functional recovery after open versus laparoscopic colonic resection. Ann Surg 241: 416–423

    Article  Google Scholar 

  8. Kehlet H, Wilmore DW (2005) Fast-track surgery. Br J Surg 92: 3–4

    Article  CAS  Google Scholar 

  9. Liu S (2004) Anesthesia and analgesia for colon surgery. Reg Anesth Pain Med 29: 52–57

    Article  Google Scholar 

  10. Carli F, Trudel J, Belliveau P (2001) The effect of intraoperative thoracic epidural anesthesia and postoperative analgesia on bowel function after colorectal surgery. Dis Colon Rectum 44: 1083–1089

    Article  CAS  Google Scholar 

  11. Neudecker J, Schwenk W, Junghans T, Pietsch S, Bohm B, Muller JM (1999) Randomized controlled trial to examine the influence of thoracic epidural analgesia on postoperative ileus after laparoscopic sigmoid resection. Br J Surg 86: 1292–1295

    Article  CAS  Google Scholar 

  12. Senagore AJ, Whalley D, Delaney CP, Mekhail N, Duepree HJ, Fazio VW (2001) Epidural anesthesia-analgesia shortens length of stay after laparoscopic segmental colectomy for benign pathology. Surgery 129: 672–676

    Article  CAS  Google Scholar 

  13. Kehlet H, Holte K (2001) Review of postoperative ileus. Am J Surg 182: 3S–10S

    Article  CAS  Google Scholar 

  14. The Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. New Engl J Med 350: 2050–2059

    Article  Google Scholar 

  15. Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopic-assisted colectomy versus open colectomy for treatment of nonmetastatic colon cancer: a randomized trial. Lancet 359: 2224–2229

    Article  Google Scholar 

  16. Leroy J Jamali F, Forbes L, Smith M, Rubino F, Mutter D, Marescaux J (2004) Laparoscopic total mesorectal excision (TME) for colorectal cancer: long-term outcomes. Surg Endosc 18: 281–289

    Article  CAS  Google Scholar 

  17. Bardram L, Funch-Jensen P, Gensen P, Crawford ME, Kehlet H (1995) Recovery after laparoscopic colonic surgery with epidural analgesia, and early oral nutrition and mobilization. Lancet 345: 763–764

    Article  CAS  Google Scholar 

  18. Senagore AJ, Delaney CP, Mekhail N, Dgan A, Fazio VW (2003) Randomized clinical trial comparing epidural anaesthesia and patient-controlled analgesia after laparoscopic segmental colectomy. Br J Surg 90: 1195–1199

    Article  CAS  Google Scholar 

  19. Zutshi M, Delaney C, Senagore AJ, Mekhail N, Lewis B, Connor JT, Fazio 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: 268–272

    Article  Google Scholar 

  20. Carli F, Kehlet H (2005) Continuous epidural analgesia for colonic surgery: but what about the future? Reg Anesth Pain Med 30: 140–142

    Article  Google Scholar 

  21. Carli F, Mayo N (2001) Measuring the outcome of surgical procedures: what are the challenges? Br J Anaesth 87: 531–533

    Article  CAS  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to F. Carli.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Taqi, A., Hong, X., Mistraletti, G. et al. 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. Surg Endosc 21, 247–252 (2007). https://doi.org/10.1007/s00464-006-0069-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-006-0069-5

Keywords

Navigation