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Marret E, Remy C, Bonnet F. Meta-analysis of epidural analgesia versus parenteral opioid analgesia after colorectal surgery. Br J Surg. 94: 665-673

Department of Anaesthetics and Intensive Care, Tenon University Hospital, Assistance Publique, Hôpitaux de Paris, University of Pierre and Marie Curie, Paris, France.
British Journal of Surgery (Impact Factor: 5.21). 06/2007; 94(6):665-73. DOI: 10.1002/bjs.5825
Source: PubMed

ABSTRACT Epidural analgesia (EA) with local anaesthetic is considered to play a key role after colorectal surgery. However, its effect on postoperative recovery is still a matter of debate.
A systematic review of randomized controlled trials comparing postoperative EA and parenteral opioid analgesia after colorectal surgery was performed. The effect on postoperative recovery was evaluated in terms of length of hospital stay, pain intensity, duration of postoperative ileus, incidence of postoperative complications and side-effects.
Sixteen trials published between 1987 and 2005 were included. EA significantly reduced pain scores and duration of ileus (weighted mean difference - 1.55 (95 per cent confidence interval (c.i.) - 2.27 to - 0.84) days). On the other hand, it was associated with a significant increase in the incidence of pruritus (odds ratio (OR) 4.8 (95 per cent c.i. 1.3 to 17.0)), urinary retention (OR 4.3 (1.2 to 15.9)) and arterial hypotension (OR 13.5 (4.0 to 57.7)). EA did not influence duration of hospital stay.
Despite improved analgesia and a decrease in ileus, EA has some adverse effects and does not shorten the duration of hospital stay after colorectal surgery.

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    • "The role of epidural anesthesia or regional anesthesia in fast-track rehabilitation program should be stressed. Postoperative epidural analgesia can avoid stress-induced neurological, endocrinological and homeostatic changes or the blocking of sympathetic nerve-related surgical stress response, reduce complications such nausea, vomiting and enteroparalysis after operation, early ambulation, improve the intestinal function and shorten the hospital stay time of patients after resection of gastric cancer.[17181920212223] "
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    ABSTRACT: OBJECTIVE: To evaluate the safety and efficacy of early rehabilitation after surgery program (ERAS) in patients undergoing laparoscopic assisted total gastrectomy. MATERIALS AND METHODS: This is a study where 47 patients who are undergoing lap assisted total gastrectomy are selected. Twenty-two (n = 22) patients received enhanced recovery programme (ERAS) management and rest twenty-five (n = 25) conventional management during the perioperative period. The length of postoperative hospital stay, time to passage of first flatus, intraoperative and postoperative complications, readmission rate and 30 day mortality is compared. Serum levels of C-reactive protein pre-operatively and also on post-op day 1 and 3 are compared. RESULTS: Postoperative hospital stay is shorter in ERAS group (78 ± 26 h) when compared to conventional group (140 ± 28 h). ERAS group passed flatus earlier than conventional group (37 ± 9 h vs. 74 ± 16 h). There is no significant difference in complications between the two groups. Serum levels of CRP are significantly low in ERAS group in comparison to conventional group. [d1 (52.40 ± 10.43) g/L vs. (73.07 ± 19.32) g/L, d3 (126.10 ± 18.62) g/L vs. (160.72 ± 26.18) g/L)]. CONCLUSION: ERAS in lap-assisted total gastrectomy is safe, feasible and efficient and it can ameliorate post-operative stress and accelerate postoperative rehabilitation in patients with gastric cancer. Short term follow up results are encouraging but we need long term studies to know its long term benefits.
    Journal of Minimal Access Surgery 07/2014; 10(3):132-8. DOI:10.4103/0972-9941.134876 · 1.37 Impact Factor
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    • "Epidural anesthesia and analgesia may block the sympathetic response that has been reported to be involved in delirium [37]. The analgesic agent used in FTS group was ropivacaine, which can alleviate moderate to severe postoperative pains effectively and safely [38]. Together, these measures can help reduce the various stimuli to the patients during surgical injury, minimize postoperative inflammatory reaction, and facilitate functional recovery. "
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    ABSTRACT: This study aims to investigate the role of fast-track surgery in preventing the development of postoperative delirium and other complications in elderly patients with colorectal carcinoma. A total of 240 elderly patients with colorectal carcinoma (aged ≥70 years) undergoing open colorectal surgery was randomly assigned into two groups, in which the patients were managed perioperatively either with traditional or fast-track approaches. The length of hospital stay (LOS) and time to pass flatus were compared. The incidence of postoperative delirium and other complications were evaluated. Serum interleukin-6 (IL-6) levels were determined before and after surgery. The LOS was significantly shorter in the fast-track surgery (FTS) group than that in the traditional group. The recovery of bowel movement (as indicated by the time to pass flatus) was faster in the FTS group. The postoperative complications including pulmonary infection, urinary infection and heart failure were significantly less frequent in the FTS group. Notably, the incidence of postoperative delirium was significantly lower in patients with the fast track therapy (4/117, 3.4 %) than with the traditional therapy (15/116, 12.9 %; p = 0.008). The serum IL-6 levels on postoperative days 1, 2, and 3 in patients with the fast-track therapy were significantly lower than those with the traditional therapy (p < 0.001). Compared to traditional perioperative management, fast-track surgery decreases the LOS, facilitates the recovery of bowel movement, and reduces occurrence of postoperative delirium and other complications in elderly patients with colorectal carcinoma. The lower incidence of delirium is at least partly attributable to the reduced systemic inflammatory response mediated by IL-6.
    Langenbeck s Archives of Surgery 12/2013; 399(1). DOI:10.1007/s00423-013-1151-9 · 2.16 Impact Factor
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    • "EDA is a feasible analgesia technique as concerns compliance and side effects if the catheter is correctly located corresponding to the origin of pain. However, EDA is not a predictor of faster and easier recovery [3]. "
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    ABSTRACT: Aim This study investigated the effect of high frequency transcutaneous electric nerve stimulation (TENS) as a pain relieving complementary therapy at the transition from epidural (EDA) to general analgesia after pancreatic surgery by horizontal, abdominal incision. Method Fifty-five consecutive patients undergoing pancreatic resection were enrolled in the study and randomly assigned to active or sham TENS treatment. Twenty subjects were included in the analysis. Pain, quality of recovery and additional analgesia consumption were measured during the 24 hours of transition from EDA to general analgesia. Results Additional analgesic consumption and pain estimations at 24 hours after EDA termination differed between the two groups, but was not statistically significant. Conclusion This study did not find support to reject use of high frequency TENS as complement during transition from EDA to general analgesia after major abdominal surgery with horizontal incision.
    Complementary therapies in clinical practice 11/2013; Accepted for publication 13 November 2013. DOI:10.1016/j.ctcp.2013.11.004
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