Enhancing the Enhanced Recovery Program in Colorectal Surgery - Use of Extended-Release Epidural Morphine (DepoDur®)

Abstract

PurposeDepoDur® is a single-dose extended-release morphine injection into the epidural space. It is not commonly used, but has many advantages over traditional analgesic regimens. We analyzed a number of these advantages in our case series in the context of the colorectal enhanced recovery program (ERP) and aimed to show that the ERP could be further enhanced by using DepoDur®.MethodsWe conducted a prospective audit of all patients undergoing open and laparoscopic colorectal procedures where DepoDur® was used between July 2010 and April 2012. Validated pain scores were used, and primary outcome measures were resting and dynamic pain, mobilization, and need for additional analgesia.ResultsTwo hundred eighty patients were included in the case series. Good pain control was seen at 24 and 48 hours. Eighty-one percent of the patients required simple analgesia alone at 24 hours, and 62% required simple analgesia (paracetamol +/- nonsteroidal anti-inflammatory drugs) alone at 48 hours. Only a minority required additional oramorph and patient-controlled analgesia at 24 and 48 hours (19% at 24 hours and 38% at 48 hours). Seventy-nine percent of the patients were mobilized at 24 hours, and 88% of the patients were mobilized at 48 hours.ConclusionDepoDur® is an effective alternative to conventional pain management techniques and may have a role in further enhancing the ERP.

Clinical Translation of Nanomedicine

“…DepoDur has been studied in a number of other surgical procedures such as cesarean section and colorectal surgery, and the results are similar to the above-mentioned studies, excellent pain control with less need for breakthrough pain medications. 139 …”

Postoperative pain management in the postanesthesia care unit: an update

“…46 EREM is also found to be an effective alternative to conventional pain management techniques and may have a role in further enhancing the enhanced recovery program after colorectal surgery. 47 However, more evidences should be obtained regarding EREM’s risk of respiratory depression and indication for usage in the PACU. 48 An iontophoretic transdermal system (ITS), when used for administering fentanyl for postoperative pain management, was associated with a better ease-of-care profile and greater ease of mobility.…”

Protocol for a multicentre, prospective, observational cohort study of variation in practice in perioperative analgesic strategies in elective laparoscopic colorectal surgery: the LapCoGesic Study

“…11 12 However, applying the same analgesic principles in the laparoscopic setting has not produced the same results in this cohort of patients, with reports of longer length of stay and delayed return of gastrointestinal function associated with the use of epidural analgesia. [13][14][15] This has led to a number of alternative analgesic strategies being employed in laparoscopic colorectal surgery, including the use of spinal analgesia, [15][16][17][18][19] patient-controlled analgesia (PCA), [20][21][22] subcutaneous and/or intraperitoneal local anaesthetics, local anaesthetic wound infiltration catheters 23 24 and transversus abdominis plane (TAP) blocks. [25][26][27][28] There have been a number of cohort studies and randomised controlled trials comparing different analgesic modalities with encouraging results; however, these studies are often single-armed or double-armed studies, comparing only one or two analgesic modalities.…”