The effect of intraoperative thoracic epidural anesthesia and postoperative analgesia on bowel function after colorectal surgery - A prospective, randomized trial

PURPOSE: Colorectal surgery is associated with postoperative ileus, which c ontributes to delayed discharge. This study was designed to investigate the effect of thoracic epidural anesthesia and analgesia on gastrointestinal f unction after colorectal surgery under standardized controlled postoperativ e care. METHODS: Forty-two patients diagnosed with either colonic cancer, d iverticulitis, polyps, or adenoma, and scheduled for elective colorectal su rgery, were randomly assigned to either postoperative patient-controlled an algesia (PCA) with intravenous morphine (n = 21) or epidural analgesia with a mixture of bupivacaine and fentanyl (n = 21). Postoperative early oral f eeding and assistance to mobilization were offered to all patients. Pain vi sual analog scale (1-100 mm), passage of flatus and bowel movements, length of hospital stay, and readiness for discharge were recorded. RESULTS: Pain visual analog scale (visual analog scale, 1-100 mm) at rest, on coughing, and daily on mobilization was significantly lower in the epidural group com pared with the patient-controlled analgesia group. Median values for the vi sual analog scale group were 7 (95 percent confidence interval, 2-18) mm 19 (95 percent confidence interval, 4-38) mm, and 10 (95 percent confidence i nterval, 5-33) mm, respectively, and, for the patient-controlled analgesia group, were 24 (95 percent confidence interval, 18-51) mm, 59 (95 percent c onfidence interval, 33-74) mm, and 40 (95 percent confidence interval, 29-7 9) min, respectively (P < 0.01). Intake of protein and calories and time ou t of bed were similar in both groups. Mean time intervals +/- standard devi ation from surgery to first flatus and first bowel movement occurred earlie r in the epidural group, 1.9 +/- 0.6 days and 3.1 +/- 1.7, days, respective ly, compared with patient-controlled analgesia, 3.6 +/- 1.5 days and 4.6 +/ - 1.6 days, respectively (P < 0.01). Postoperative complications occurred i n 33 percent of the patient-controlled analgesia group and 28 percent of th e epidural group. There was no significant difference in length of hospital stay between the two groups with a mean of 7.3 +/- 3.7 days in the patient -controlled analgesia group and 8.5 +/- 4.2 days in the epidural group. Rea diness for discharge was similar in both groups. CONCLUSION: Thoracic epidu ral analgesia has distinct advantages over patient-controlled analgesia mor phine in providing superior quality of analgesia and shortening the duratio n of postoperative ileus. However, discharge home was not faster, indicatin g that other perioperative factors influence the length of hospital stay.