EPIDURAL-ANESTHESIA ACCELERATES THE RECOVERY OF POSTISCHEMIC BOWED MOTILITY IN THE RAT

Background: Intestinal ischemia is associated with derangement of gast rointestinal motility. Uncontrolled clinical observations that bupivac aine injected into the epidural space causes faster recovery of bowel motility after various abdominal operations led us to assess the hypot hesis that epidural anesthesia can hasten the recovery of gastrointest inal motility in the immediate postischemic period. Methods: Gut motil ity studies were performed in rats in which epidural anesthesia and in testinal ischemia could be initiated without the need to provoke surgi cal trauma. Epidural Lidocaine was compared to epidural saline in thei r effect on intestinal motility after a 30-min period of bowel ischemi a. Results: Total ischemia to the small bowel resulted in pronounced p ostischemic adynamic ileus as evidenced by only 0.7% of the total leng th of the small bowel filled with a marker meal at the end of the stud y period (transit index) compared with 84.4% in the control group. Lid ocaine epidural anesthesia caused significantly more rapid resolution of the adynamic ileus (60.3% of the bowel filled with the marker meal vs. 30.9% in the controls in which saline was injected). Conclusions: Epidural lidocaine compared to epidural saline hastens the recovery of gastrointestinal motility in rats after a 30-min period of bowel isch emia. This effect may be elicited by attenuation of sympathetic effere nt inhibitory pathways or by vasodilatation caused by the sympathetic block. These results suggest that lidocaine epidural block not only al leviates pain in situations of ischemic injury to the bowel but may al so hasten the recovery from postischemic paralytic ileus.