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Influence of thoracic epidural analgesia on postoperative pain relief and ileus after laparoscopic colorectal resection

Benefit with epidural analgesia

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Thoracic epidural analgesia (TEA) provides superior analgesia with a lower incidence of postoperative ileus when compared with systemic opiate analgesia in open colorectal surgery. However, in laparoscopic colorectal surgery the role of TEA is not well defined. This prospective observational study investigates the influence of TEA in laparoscopic colorectal resections.


All patients undergoing colorectal resection between November 2004 and February 2007 were assessed for inclusion into a prospective randomized trial investigating the influence of bisacodyl on postoperative ileus. All patients treated by laparoscopic resection from this collective were eligible for the present study. Primary endpoints were use of analgesics and visual analogue scale (VAS) pain scores. Secondary endpoint concerned full gastrointestinal recovery, defined as the mean time to the occurrence of the following three events (GI-3): first flatus passed, first defecation, and first solid food tolerated.


75 patients underwent laparoscopic colorectal resection, 39 in the TEA group and 36 in the non-TEA group. Patients with TEA required significantly less analgesics (metamizol median 3.0 g [0–32 g] versus 13.8 g [0–28 g] (p < 0.001); opioids mean 12 mg [±2.8 mg standard error of mean, SEM] versus 103 mg [±18.2 mg SEM] (p < 0.001). VAS scores were significantly lower in the TEA group (overall mean 1.67 [± 0.2 SEM] versus 2.58 [±0.2 SEM]; p = 0.004). Mean time to gastrointestinal recovery (GI-3) was significantly shorter (2.96 [±0.2 SEM] days versus 3.81 [±0.3 SEM] days; p = 0.025). Analysis of the subgroup of patients with laparoscopically completed resections showed corresponding results.


TEA provides a significant benefit in terms of less analgesic consumption, better postoperative pain relief, and faster recovery of gastrointestinal function in patients undergoing laparoscopic colorectal resection.

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  1. Mann C, Pouzeratte Y, Boccara G, Peccoux C, Vergne C, Brunat G, Domergue J, Millat B, Colson P (2000) Comparison of intravenous or epidural patient-controlled analgesia in the elderly after major abdominal surgery. Anesthesiology 92:433–441

    Article  PubMed  CAS  Google Scholar 

  2. Rigg JRA, Jamrozik K, Myles PS, Silbert BS, Peyton PJ, Parsons RW, Collins KS (2002) Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet 359:1276–1282

    Article  PubMed  Google Scholar 

  3. Steinberg RB, Liu SS, Wu CL, Mackey DC, Grass JA, Ahlen K, Jeppsson L (2002) Comparison of ropivacaine-fentanyl patient-controlled epidural analgesia with morphine intravenous patient-controlled analgesia for perioperative analgesia and recovery after open colon surgery. J Clin Anesth 14:571–577

    Article  PubMed  CAS  Google Scholar 

  4. Carli F, Trudel JL, 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  PubMed  CAS  Google Scholar 

  5. Gendall KA, Kennedy RR, Watson AJM, Frizelle FA (2007) The effect of epidural analgesia on postoperative outcome after colorectal surgery. Colorectal Dis 9(7):584–598

    Article  PubMed  CAS  Google Scholar 

  6. Scott NB, James K, Murphy M, Kehlet H (1996) Continuous thoracic epidural analgesia versus combined spinal/thoracic epidural analgesia on pain, pulmonary function and the metabolic response following colonic resection. Acta Anaesthesiol Scand 40:691–696

    Article  PubMed  CAS  Google Scholar 

  7. Wind J, Polle SW, Fung Kon Jin PHP, Dejong CHC, von Meyenfeldt MF, Ubbink DT, Gouma DJ, Bemelman WA (2006) Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg 93:800–809

    Article  PubMed  CAS  Google Scholar 

  8. Zutshi M, Delaney CP, 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(3):268–272

    Article  PubMed  Google Scholar 

  9. Holte K, Kehlet H (2002) Prevention of postoperative ileus. Minerva Anesthesiol 68(4):152–156

    CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  11. Hildebrandt U, Kessler K, Plusczyk T, Pistorius G, Vollmar B, Menger MD (2003) Comparison of surgical stress between laparoscopic and open colonic resections. Surg Endosc 17:242–246

    Article  PubMed  CAS  Google Scholar 

  12. 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  PubMed  CAS  Google Scholar 

  13. Abraham NS, Byrne CM, Young JM, Solomon MJ (2007) Meta-analysis of non-randomized comparative studies of the short-term outcomes of laparoscopic resection for colorectal cancer. ANZ J Surg 77:508–516

    Article  PubMed  Google Scholar 

  14. Basse L, Jakobsen Hjort D, Bardram L, Billesbølle P, Lund C, Morgensen T, Rosenberg J, Kehlet H (2005) Functional recovery after open versus laparoscopic colonic resection. Ann Surg 241:416–423

    Article  PubMed  Google Scholar 

  15. Basse L, Madsen JL, Billesbølle P, Bardram L, Kehlet H (2003) Gastrointestinal transit after laparoscopic vs. open colonic resection. Surg Endosc 17:1919–1922

    Article  PubMed  CAS  Google Scholar 

  16. King PM, Blazeby JM, Ewings P, Franks PJ, Longman RJ, Kendrick AH, Kipling RM, Kennedy RH (2006) Randomized clinical trial comparing laparoscopic and open surgery for colorectal cancer within an enhanced recovery programme. Br J Surg 93:300–308

    Article  PubMed  CAS  Google Scholar 

  17. 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  PubMed  CAS  Google Scholar 

  18. Taqi A, Hong X, Mistraletti G, Stein B, Charlebois P, Carli F (2007) 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

    Article  PubMed  CAS  Google Scholar 

  19. Senagore AJ, Delaney CP, Mekhail N, Dugan 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  PubMed  CAS  Google Scholar 

  20. Neudecker J, Schwenk W, Junghans T, Pietsch S, Böhm B, Müller 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  PubMed  CAS  Google Scholar 

  21. Fearon KCH, Ljungqvist O, von Meyenfeldt M, Revhaug A, Dejong CHC, 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 24:466–477

    Article  PubMed  CAS  Google Scholar 

  22. Raue W, Haase O, Junghans T, Scharfenberg M, Müller JM, Schwenk W (2004) “Fast-track” multimodal rehabilitation program improves outcome after laparoscopic sigmoidectomy. Surg Endosc 18:1463–1468

    Article  PubMed  CAS  Google Scholar 

  23. Schwenk W, Böhm B, Haase O, Junghans T, Müller JM (1998) Laparoscopic versus conventional colorectal resection: a prospective randomised study of postoperative ileus and early postoperative feeding. Langenbecks Arch Surg 383:49–55

    Article  PubMed  CAS  Google Scholar 

  24. Kehlet H (2006) Future perspectives and research initiatives in fast-track surgery. Langenbecks Arch Surg 391:495–498

    Article  PubMed  Google Scholar 

  25. Horlocker TT, Wedel DJ (2000) Neurologic complications of spinal and epidural anesthesia. Reg Anesth Pain Med 25:83–98

    Article  PubMed  CAS  Google Scholar 

  26. Dawson SJ, Small H, Logan MN, Geringer S (2000) Case control study of epidural catheter infections in a district general hospital. Comm Dis Public Health 3:300–302

    CAS  Google Scholar 

  27. Holte K, Kehlet H (2001) Epidural analgesia and risk of anastomotic leakage. Reg Anesth Pain Med 26:111–117

    Article  PubMed  CAS  Google Scholar 

  28. Ryan P, Schweitzer SA, Woods RJ (1992) Effect of epidural and general anaesthesia compared with general anaesthesia alone in large bowel anastomosis. Eur J Surg 158:45–49

    PubMed  CAS  Google Scholar 

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We thank Dr. Karen Delport, MD, for assistance in preparing the manuscript in English.

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Correspondence to Urs Zingg.

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Zingg, U., Miskovic, D., Hamel, C.T. et al. Influence of thoracic epidural analgesia on postoperative pain relief and ileus after laparoscopic colorectal resection. Surg Endosc 23, 276–282 (2009).

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