Use of Epidural Analgesia in Sigmoidectomy: Is There Any Advantage in the Era of Minimally Invasive Surgery?

Overview

Journal J Gastrointest Surg

Specialty Gastroenterology

Date 2018 Jun 27

PMID 29943135

Citations 1

Authors

Mafalda Borges Teixeira

Yu-Ting van Loon

Dareczka K Wasowicz

Barbara S Langenhoff

Roland P van Ieperen

David D E Zimmerman

Affiliations

Soon will be listed here.

Abstract

Background: There is no consensus as to the effects of epidural analgesia on postoperative outcomes after laparoscopy in the context of the Enhanced Recovery Programs. The aim of this study was to evaluate the effects of epidural analgesia on postoperative outcomes after elective laparoscopic sigmoidectomy.

Methods: The use of epidural analgesia was discontinued in elective laparoscopic sigmoidectomy and substituted by the perioperative administration of systemic lidocaine. Data from patients undergoing elective laparoscopic sigmoidectomy between January 2014 and September 2016 was prospectively analysed. Patients with epidural analgesia were compared with patients without, in analgesics administrated postoperatively, length of stay, day of first defecation and mobilisation, and complication and reoperation rates.

Results: A total of 160 patients (male 85; female 75), median age 68 (30-92 years), were included. The groups consisted of 80 patients each. Mean length of stay (5.6 vs. 7.2 days, p = 0.03) and day of first mobilisation (mean 1.2 vs. 1.6 days, p = 0.004) were significantly shorter in the group without epidural analgesia. Reoperation rate (7.5 vs. 2.5%) was not statistically different. Complication rate was significantly lower (12.5 vs. 30%, p = 0.007) in the group without epidural. Day of first defecation was shorter in the epidural group (1.4 vs. 1.7 days, p = 0.04). Mean amount of analgesics administrated was not statistically different between groups, except for metamizole, that was administrated more in the group without epidural.

Conclusions: Epidural analgesia did not offer benefits on postoperative analgesia or outcomes after elective laparoscopic sigmoidectomy, causing longer length of stay, later mobilisation and higher complication rate.

Citing Articles

Evaluation of Enhanced Recovery After Following a Surgical Protocol for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis.

Duzgun O Med Arch. 2019; 73(5):331-337.

PMID: 31819307 PMC: 6885212. DOI: 10.5455/medarh.2019.73.331-337.

References

Haverkamp M, de Roos M, Ong K . The ERAS protocol reduces the length of stay after laparoscopic colectomies. Surg Endosc. 2011; 26(2):361-7. DOI: 10.1007/s00464-011-1877-9. View

Gendall K, Kennedy R, Watson A, Frizelle F . The effect of epidural analgesia on postoperative outcome after colorectal surgery. Colorectal Dis. 2007; 9(7):584-98. DOI: 10.1111/j.1463-1318.2007.1274.x. View

Kaba A, Laurent S, Detroz B, Sessler D, Durieux M, Lamy M . Intravenous lidocaine infusion facilitates acute rehabilitation after laparoscopic colectomy. Anesthesiology. 2007; 106(1):11-8. DOI: 10.1097/00000542-200701000-00007. View

Melnyk M, Casey R, Black P, Koupparis A . Enhanced recovery after surgery (ERAS) protocols: Time to change practice?. Can Urol Assoc J. 2011; 5(5):342-8. PMC: 3202008. DOI: 10.5489/cuaj.11002. View

Harvey K, Adair J, Isho M, Robinson R . Can intravenous lidocaine decrease postsurgical ileus and shorten hospital stay in elective bowel surgery? A pilot study and literature review. Am J Surg. 2009; 198(2):231-6. DOI: 10.1016/j.amjsurg.2008.10.015. View

Levy B, Tilney H, Dowson H, Rockall T . A systematic review of postoperative analgesia following laparoscopic colorectal surgery. Colorectal Dis. 2009; 12(1):5-15. DOI: 10.1111/j.1463-1318.2009.01799.x. View

Madsen T, McLean S, Zhai W, Linnstaedt S, Kurz M, Swor R . Gender Differences in Pain Experience and Treatment after Motor Vehicle Collisions: A Secondary Analysis of the CRASH Injury Study. Clin Ther. 2018; 40(2):204-213.e2. PMC: 5811333. DOI: 10.1016/j.clinthera.2017.12.014. View

Marret E, Rolin M, Beaussier M, Bonnet F . Meta-analysis of intravenous lidocaine and postoperative recovery after abdominal surgery. Br J Surg. 2008; 95(11):1331-8. DOI: 10.1002/bjs.6375. View

Levy B, Scott M, Fawcett W, Fry C, Rockall T . Randomized clinical trial of epidural, spinal or patient-controlled analgesia for patients undergoing laparoscopic colorectal surgery. Br J Surg. 2011; 98(8):1068-78. DOI: 10.1002/bjs.7545. View

10.

Gillissen F, Hoff C, Maessen J, Winkens B, Teeuwen J, von Meyenfeldt M . Structured synchronous implementation of an enhanced recovery program in elective colonic surgery in 33 hospitals in The Netherlands. World J Surg. 2013; 37(5):1082-93. DOI: 10.1007/s00268-013-1938-4. View

11.

Marret E, Remy C, Bonnet F . Meta-analysis of epidural analgesia versus parenteral opioid analgesia after colorectal surgery. Br J Surg. 2007; 94(6):665-73. DOI: 10.1002/bjs.5825. View

12.

Nygren J, Thacker J, Carli F, Fearon K, Norderval S, Lobo D . Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS(®)) Society recommendations. World J Surg. 2012; 37(2):285-305. DOI: 10.1007/s00268-012-1787-6. View

13.

Raue W, Haase O, Junghans T, Scharfenberg M, Muller J, Schwenk W . 'Fast-track' multimodal rehabilitation program improves outcome after laparoscopic sigmoidectomy: a controlled prospective evaluation. Surg Endosc. 2005; 18(10):1463-8. DOI: 10.1007/s00464-003-9238-y. View

14.

Dindo D, Demartines N, Clavien P . Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2):205-13. PMC: 1360123. DOI: 10.1097/01.sla.0000133083.54934.ae. View

15.

Halabi W, Jafari M, Nguyen V, Carmichael J, Mills S, Stamos M . A nationwide analysis of the use and outcomes of epidural analgesia in open colorectal surgery. J Gastrointest Surg. 2013; 17(6):1130-7. DOI: 10.1007/s11605-013-2195-4. View

16.

Turunen P, Carpelan-Holmstrom M, Kairaluoma P, Wikstrom H, Kruuna O, Pere P . Epidural analgesia diminished pain but did not otherwise improve enhanced recovery after laparoscopic sigmoidectomy: a prospective randomized study. Surg Endosc. 2008; 23(1):31-7. DOI: 10.1007/s00464-008-0100-0. View

17.

Kehlet H . Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997; 78(5):606-17. DOI: 10.1093/bja/78.5.606. View

18.

Guenaga K, Matos D, Wille-Jorgensen P . Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev. 2011; (9):CD001544. PMC: 7066937. DOI: 10.1002/14651858.CD001544.pub4. View

19.

Senagore A, Delaney C, Mekhail N, Dugan A, Fazio V . Randomized clinical trial comparing epidural anaesthesia and patient-controlled analgesia after laparoscopic segmental colectomy. Br J Surg. 2003; 90(10):1195-9. DOI: 10.1002/bjs.4223. View