Epidural local anaesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery

Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations

“…A regional anaesthetic block used in addition to general anaesthesia during surgery can minimise the need for postoperative intravenous opiates, thereby allowing rapid awakening from anaesthesia which can facilitate early enteral intake and mobilisation on the day of surgery. In open surgery, the use of epidural analgesia has proven to be superior to opioid-based alternatives for several important outcomes [81], including pain [82], PONV [83] and complications [84]. In laparoscopic surgery, emerging data indicate that alternative methods such as spinal anaesthesia, intravenous lidocain and patient-controlled anaesthesia (PCA) may be equally effective [80].…”

“…No prokinetic agent has been shown to be effective in attenuating or treating postoperative ileus, but several other types of interventions have been successful. Mid-thoracic epidural analgesia [156] as compared with intravenous opioid analgesia is highly effective at preventing postoperative ileus [83,157]. Fluid overloading during [158] and after [159] surgery impairs gastrointestinal function and should be avoided.…”

“…Using low-dose concentrations of local anaesthetic combined with a short-acting opiate appears to offer the best combination of analgesia while minimising the risk of motor block and hypotension due to sympathetic blockade. Several meta-analyses have shown improved outcomes with TEA compared with opioid-based analgesia, including pain, complications, PONV and insulin resistance [81][82][83][84][85]. Hypotension induced by sympathetic block should be treated with vasopressors provided the patient is not hypovolaemic.…”

A comparison between fentanyl plus celecoxib therapy and epidural anesthesia for postoperative pain management following laparoscopic gastrectomy

“…Epidural anesthesia has been reported to decrease cardiovascular, pulmonary, and gastrointestinal morbidities, especially in high-risk patients, compared with systemic opioids [9][10][11]. However, the use of epidural anesthesia for minimally invasive procedures, such as laparoscopic cholecystectomy and laparoscopic colorectal surgery, has been limited because the benefits compared with systemic opioids were not evident [12].…”

Trans Abdominis Plan Block Reduce Postoperative Analgesic Requirement and Prolong Time to First Analgesic Request in Abdominal Surgery at University of Gondar Hospital: Prospective Observational Study

“…In patient with abdominal surgery, multimodal analgesic technique reduces morbidity, costs and hospital stay [1]. Abdominal wall incision is the major origin of pain experienced by patients after abdominal surgery [2].…”