Randomized Clinical Trial of Epidural Compared with Conventional Analgesia after Minimally Invasive Colorectal Surgery - 01/11/17
Abstract |
Background |
The effectiveness of thoracic epidural analgesia (EA) vs conventional IV analgesia (IA) after minimally invasive surgery is still unproven. We designed a randomized controlled trial comparing EA with IA after minimally invasive colorectal surgery.
Study Design |
A total of 87 patients who underwent minimally invasive colorectal procedures at a single institution between 2011 and 2014 were enrolled. Eight patients were excluded and 38 were randomized to EA and 41 to IA. Pain was assessed with the Visual Analogue Scale and quality of life with the Overall Benefit of Analgesia Score daily until discharge.
Results |
Mean age was 57 ± 14 years, 43% of patients were female, and mean BMI was 28.6 ± 6 kg/m2. The 2 groups were similar in demographic characteristics and distribution of diagnoses and procedures. Epidural analgesia had a higher incidence of hypotensive systolic blood pressure (<90 mmHg) episodes (9 vs 2; p < 0.05) and a trend toward longer Foley catheter duration (3 ± 2 days vs 2 ± 4 days; p > 0.05). Epidural and IA had equivalent mean lengths of stay (4 ± 3 days vs 4 ± 3 days), daily Visual Analogue Scale scores (2.4 ± 2.0 vs 3.0 ± 2.0), and Overall Benefit of Analgesia Scores (3.2 ± 2.0 vs 3.2 ± 2.0), and similar time to start oral diet (2.8 ± 2 days vs 2.2 ± 1 days). Epidural analgesia patients used a higher total dose of narcotics (147.5 ± 192.0 mg vs 98.1 ± 112.0 mg; p > 0.05). Epidural and IV analgesia had equivalent total hospital charges ($144,991 ± $67,636 vs $141,339 ± $75,579; p > 0.05).
Conclusions |
This study indicates that EA has no added clinical benefit in patients undergoing minimally invasive colorectal surgery. A trend toward higher total narcotics use and complications with EA was demonstrated.
Le texte complet de cet article est disponible en PDF.Abbreviations and Acronyms : EA, ERAS, IA, LOS, MIS CRS, OBAS, PCA, PO, VAS
Plan
| Disclosure Information: Nothing to disclose. |
|
| Disclosure outside the scope of this work: Drs Carmichael and Mills' institution receives an educational grant from Ethicon. Dr Pigazzi is a paid consultant for Intuitive Surgical, Cook, Ethicon, Covidien, and Cubist. Dr Stamos has been a paid consultant for Ethicon, Olympus, Gore, NiTi/NovoGI, and Adolor/GlaxoSmithKline; his institution receives grant payments for Covidien training support. |
Vol 225 - N° 5
P. 622-630 - novembre 2017 Retour au numéro
Article précédent
- Taking the Initiative: Risk-Reduction Strategies and Decreased Malpractice Costs
- Steven E. Raper, Deborah Rose, Mary Ellen Nepps, Jeffrey A. Drebin
- Surgical Antibiotic Prophylaxis and Risk for Postoperative Antibiotic-Resistant Infections
- Margot E. Cohen, Hojjat Salmasian, Jianhua Li, Jianfang Liu, Philip Zachariah, Jason D. Wright, Daniel E. Freedberg
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?