Skip to main content

Advertisement

Log in

The beneficial effects of preperitoneal catheter analgesia following colon and rectal resections: a prospective, randomized, double-blind, placebo-controlled study

  • Original Article
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

Abstract

Background

Preperitoneal catheter analgesia following abdominal surgery has attracted interest in the last decade. We conducted this study to evaluate the benefits of preperitoneal catheter analgesia in managing pain after abdominal colon and rectal resections.

Methods

A total of 50 patients undergoing colon and rectal resections for benign and malignant diseases received analgesic medicines via an epidural catheter placed just prior to surgery and a preperitoneal catheter placed at the end of the surgical procedure. Patients were instructed to use the epidural patient-controlled analgesia (PCA) device freely and were randomized into two groups after obtaining the approval of the Institutional Review Board: Group A received 10 ml of levobupivacaine twice a day postoperatively via preperitoneal catheter and group B received only 10 ml of saline. Demographics, surgical characteristics, pain scores recorded four days following surgery, analgesic volume used from the epidural PCA, clinical outcomes (length of stay, time to first bowel movement, time to first passage of gas or stool, time to first oral intake) and respiratory function test results (preoperative vs. postoperative) were compared.

Results

There were no significant differences in demographics or surgical characteristics between both groups. Pain scores were similar. Clinical outcomes and respiratory functions were comparable. The use of analgesic volume via epidural catheter was significantly lower in group A than in group B (P = 0.032).

Conclusions

Preperitoneal catheter analgesia significantly decreased the need for epidural drug consumption and proved to be a beneficial adjunct for postoperative pain management of patients who underwent colon and rectal resections.

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

Access this article

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. Kirdak T, Yilmazlar A, Cavun S, Ercan I, Yilmazlar T (2008) Does single, low-dose preoperative dexamethasone improve outcomes after colorectal surgery based on an enhanced recovery protocol? Double-blind, randomized clinical trial. Am Surg 74:160–167

    PubMed  Google Scholar 

  2. Liu SS, Richman JM, Thirlby RC, Wu CL (2006) Efficacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: a quantitative and qualitative systematic review of randomized controlled trials. J Am Coll Surg 203:914–932

    Article  PubMed  Google Scholar 

  3. Perkins FM, Kehlet H (2000) Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology 93:1123–1133

    Article  PubMed  CAS  Google Scholar 

  4. Karthikesalingam A, Walsh SR, Markar SR, Sadat U, Tang TY, Malata CM (2008) Continuous wound infusion of local anesthetic agents following colorectal surgery: systematic review and meta-analysis. World J Gastroenterol 14:5301–5305

    Article  PubMed  Google Scholar 

  5. Dahl J, Moiniche S, Kehlet H (1994) Wound infiltration with local anesthetics for postoperative pain. Acta Anaesthesiol Scand 38:7–14

    Article  PubMed  CAS  Google Scholar 

  6. PROSPECT working group (2008) Procedure specific postoperative pain management: open colonic resection. Available from: http://www.postoppain.org/frameset.htm. Accessed 28th Jan 2008

  7. Baig MK, Zmora O, Derdemezi J, Weiss EG, Nogueras JJ, Wexner SD (2006) Use of the ON-Q pain management system is associated with decreased postoperative analgesic requirement: double blind randomized placebo pilot study. J Am Coll Surg 202:297–305

    Article  PubMed  Google Scholar 

  8. Beaussier M, El’Ayoubi H, Schiffer E et al (2007) Continuous preperitoneal infusion of ropivacaine provides effective analgesia and ameliorates recovery after colorectal surgery: a randomized, double blind, placebo-controlled study. Anesthesiology 107:461–468

    Article  PubMed  CAS  Google Scholar 

  9. Cheong WK, Seow-Choen F, Eu KW, Tang CL, Heah SM (2001) Randomized clinical trial of local bupivacaine perfusion versus parenteral morphine infusion for pain relief after laparotomy. Br J Surg 88:357–359

    Article  PubMed  CAS  Google Scholar 

  10. Fredman B, Zohar E, Tarabykin A (2001) Bupivacaine wound instillation via an electronic patient-controlled analgesia device and a double catheter system does not decrease postoperative pain or opioid requirements after major abdominal surgery. Anesth Analg 92:189–193

    Article  PubMed  CAS  Google Scholar 

  11. Polglase AL, McMurrick PJ, Simpson PJ (2007) Continuous wound infusion of local anesthetic for the control of pain after elective abdominal colorectal surgery. Dis Colon Rectum 50:2158–2167

    Article  PubMed  Google Scholar 

  12. Chester JF, Ravindranath K, White BD et al (1989) Wound perfusion with bupivacaine: objective evidence for efficacy in postoperative pain relief. Ann R Coll Surg Engl 71:394–396

    PubMed  CAS  Google Scholar 

  13. Levack ID, Holmes JD, Robertson GS (1986) Abdominal wound perfusion for the relief of postoperative pain. Br J Anaesth 58:615–619

    Article  PubMed  CAS  Google Scholar 

  14. Gupta A, Perniola A, Axelsson K et al (2004) Postoperative pain after abdominal hysterectomy: a double-blind comparison between placebo and local anesthetic infused intraperitoneally. Anesth Analg 99:1173–1179

    Article  PubMed  CAS  Google Scholar 

  15. Kristensen BB, Chistensen DS, Ostergaard M et al (1999) Lack of postoperative pain relief after hysterectomy using preperitoneally administered bupivacaine. Reg Anesth Pain Med 24:576–580

    PubMed  CAS  Google Scholar 

  16. Society American Thoracic (1987) Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease and asthma. Am Rev Respir Dis 136:225–243

    Google Scholar 

  17. Cornish P, Deacon A (2007) Rectus sheath catheters for continuous analgesia after upper abdominal surgery. ANZ J Surg 77:84

    Article  PubMed  Google Scholar 

  18. Badia JM, Whawell SA, Scott-Coombes DM, Abel PD, Williamson RC, Thompson JN (1996) Peritoneal and systemic cytokine response to laparotomy. Br J Surg 83:347–348

    Article  PubMed  CAS  Google Scholar 

  19. Sammour T, Kahokehr A, Soop M, Hill AG (2010) Peritoneal damage: the inflammatory response and clinical implications of the neuro-immuno-humoral axis. World J Surg 34:704–720

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank our research nurse Sonca Erdem for her dedicated work during this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to E. Ozturk.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ozturk, E., Yilmazlar, A., Coskun, F. et al. The beneficial effects of preperitoneal catheter analgesia following colon and rectal resections: a prospective, randomized, double-blind, placebo-controlled study. Tech Coloproctol 15, 331–336 (2011). https://doi.org/10.1007/s10151-011-0720-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10151-011-0720-6

Keywords

Navigation