Impact of analgesic modality on stress response following laparoscopic colorectal surgery: a post-hoc analysis of a randomised controlled trial

Abstract

There is a significant transient attenuating effect of TEA on stress response following laparoscopic colorectal surgery and within ERAS as expressed by serum epinephrine and insulin levels. Continuous wound infusion with local anaesthetic, however, attenuates cytokine response as expressed by interleukin-6.

Ropivacaine preperitoneal wound infusion for pain relief and prevention of incisional hyperalgesia after laparoscopic colorectal surgery: a randomized, triple‐arm, double‐blind controlled evaluation vs intravenous lidocaine infusion, the CATCH study

“… compared preperitoneal CWI with epidural analgesia and reported excellent analgesic efficacy in the CWI group with no difference in hospital stay between the two groups. The same investigators showed that pain and opiate consumption during the two postoperative days after laparoscopic colorectal resections did not differ between the epidural and CWI groups . Several parameters could explain the discrepancies between these results, such as the catheter location (preperitoneal vs subcutaneous) and local anaesthetic flow rates.…”

“…Finally, according to some recent reports, it is thought that an analgesic strategy may influence the stress response after laparoscopic colorectal surgery . Stress response corresponds to the initiation of a cascade of neuroendocrine, metabolic and inflammatory responses induced by the surgical injury.…”

Role of Epidural Analgesia within an ERAS Program after Laparoscopic Colorectal Surgery: A Review and Meta-Analysis of Randomised Controlled Studies

“…All included studies in the present meta-analysis are randomised and in all studies [7–12] the random sequence generation and allocation concealment were reported and were unclear just in one study, giving strength to the results of the meta-analysis. However, although blinding is very important when evaluating pain control, only the study by Boulind et al [10] was blind.…”

Perioperative humoral stress response to laparoscopic versus open aortobifemoral bypass surgery

“…Using spinal or epidural anaesthesia reduce hormonal stress [46,47]. (table IV), but this sub-study was neither aimed nor designed or powered to investigate any correlation.…”