Randomized controlled trial comparing the controlled rehabilitation with early ambulation and diet pathway versus the controlled rehabilitation with early ambulation and diet with preemptive epidural anesthesia/analgesia after laparotomy and intestinal resection - 18/08/11

Doi : 10.1016/j.amjsurg.2004.11.012

Massarat Zutshi, M.D ^a, Conor P. Delaney, M.D., M.Ch., Ph.D. ^a,^⁎ , Anthony J. Senagore, M.D., M.S. ^a : F.A.C.S., Nagy Mekhail, M.D. ^c, Brenda Lewis, D.O. ^b, Jason T. Connor, M.S. ^d, Victor W. Fazio, M.D. ^a
^a Department of Colorectal Surgery/A-30, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
^b Department of Anesthesia, Cleveland Clinic Foundation, Cleveland, OH, USA
^c Department of Pain Management, Cleveland Clinic Foundation, Cleveland, OH, USA
^d Department of Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, OH, USA

Corresponding author. Tel: +1-216-445-1647; fax: +1-216-445-8627.

Abstract

Background

Multimodal postoperative care regimens accelerate recovery after abdominal surgery. The benefit of thoracic epidural (TE) analgesia over patient-controlled analgesia (PCA) remains unproven when used with a fast-track postoperative care plan.

Methods

Fifty-six patients undergoing major intestinal resection, and on a fast-track postoperative care plan, were randomized to preemptive TE or PCA. Patients were evaluated at standard time points for pain score, quality of life (Short Form-36), and complications. Oral analgesia was substituted for TE and PCA on the second postoperative day. Discharge criteria were identical for both groups.

Results

Six patients (20.6%) had a failed epidural. There was no difference in length of stay (5.8 versus 6.2 days, TE versus PCA, P = .55), total length of stay (including readmissions), pain scores, quality of life, complications, or hospital costs at any time point.