Epidural anesthesia-analgesia shortens length of stay after laparoscopic segmental colectomy for benign pathology

Background. Aggressive postoperative care plans after open colectomy may al low earlier discharge, especially in conjunction with preoperative thoracic epidural anesthesia-analgesia using a local anesthetic and narcotic. The p urpose of this study was to evaluate the role of thoracic epidural anesthes ia-analgesia using bupivacaine and fentanyl citrate in reducing lengths of stay after laparoscopic colectomy (LAC). Methods. A consecutive cohort of patients who underwent LAC and who receive d perioperative thoracic epidural anesthesia-analgesia (TEG) was compared w ith a standard group of patients (STD) undergoing LAC during the 2 months p receding the implementation of the epidural management protocol. Patients w ith TEG received 6 to 8 mL bupivacaine (0.25%) and fentanyl citrate (100 mu g) through a T8-9 or a T9-10 epidural catheter before the incision was made and a postoperative infusion of bupivacaine (0.1%) and fentanyl citrate ( 5 mug/mL) at 4 to 6 mL/h for 18 hours. STD patients had supplemental intrav enous morphine. The postoperative care plane was otherwise identical betwee n the 2 groups. Patients were matched by sex, age, and type of segmental re section. Discharge criteria included tolerance of 3 general diet meals, pas sage of flatus or stool and adequate oral analgesia. Length of stay was def ined as the time from admission for the surgical procedure to discharge fro m the hospital. Statistical analysis included a Student t test, Wilcoxon ra nk sum test, chi-square trend test, and Fisher exact test where appropriate . Data are presented as mean +/- SEM. Results. Procedures. performed: right hemicolectomy-ileocolectomy (TEG, n = 5; STD, n = 5); or sigmoid colectomy-rectopexy (TEG, n = 17; STD, n = 17). There was no significant difference with respect to operating room (OR) ti me (TEG, 102 +/- 12 minutes; STD, 87 +/- 17 minutes), body mass index (TEG, 26 +/- 2; STD, 26 +/- 2), or American Society of Anesthesiologists class ( I-III) distribution (TEG, 3/12/10; STD, 4/11/7), or mean incision length (T EG, 3.5 +/- 0.4 cm; STD, 3.7 +/-0.3 cm). No postoperative complications or readmissions occurred in either group. The length of stay decreased in the TEG group (TEG, 2.8 +/- 0.2 days; STD, 3.9 +/- 0.3; P < .001) and the media n length of stay for the 2 groups was similarly less (TEG, 2 days; STD, 3 d ays). Conclusions. These data suggest that thoracic epidural anesthesia-analgesia has a significant and favorable impact on dietary tolerance and length of stay after LAC. A thoracic epidural appears to an important component of a postoperative care protocol, which adds further advantage to LAC without th e need for labor-intensive and costly patient care plans.