CONVALESCENCE AND HOSPITAL STAY AFTER COLONIC SURGERY WITH BALANCED ANALGESIA, EARLY ORAL-FEEDING, AND ENFORCED MOBILIZATION

Objective: To evaluate the combined effects of pain relief by continuo us epidural analgesia, early oral feeding and enforced mobilisation on convalescence and hospital stay after colonic resection. Design: Unco ntrolled pilot investigation. Setting: University hospital, Denmark. S ubjects: 17 unselected patients (median age 69 years) undergoing colon ic resection. Interventions: Patients received combined epidural and g eneral anaesthesia during operations and after operation were given co ntinuous epidural bupivacaine 0.25%, 4 mi hour and morphine 0.2 mg hou r, for 96 hours and oral paracetamol 4 g/daily. No patient had a nasog astric tube, and oral feeding with normal food and protein enriched so lutions (1000 Kcal (4180 KJ/day) was institute 24 hours postoperativel y together with intensive mobilisation. Results: Median visual analogu e pain scores were zero at rest and minimal during coughing and mobili sation, which allowed early mobilisation for up to 11 hours on the thi rd postoperative day. Gastrointestinal function with defaecation had r eturned to normal in 12 patients within the first two postoperative da ys. Median hospital stay was five days with minimal increase in fatigu e and without postoperative weight loss. Conclusion: These results sug gest that a combined approach of optimal pain relief with balanced ana lgesia. enforced early mobilisation, and oral feeding, may reduce the length of convalescence and hospital stay after colonic operations.