Influence of thoracic epidural analgesia on postoperative pain relief and ileus after laparoscopic colorectal resection

Zingg, Urs; Mišković, Danilo; Hamel, Christian; Erni, Lukas; Oertli, Daniel; Metzger, U

doi:10.1007/s00464-008-9888-x

Cited by 95 publications

(77 citation statements)

References 28 publications

(47 reference statements)

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“…23 In two recent studies, a laparoscopic approach to colon resection, together with thoracic epidural local anesthetics, contributed to accelerate the return of bowel function and dietary intake. 14,15 This physiological benefit, however, did not translate into faster hospital discharge (median of 5 days). Such findings prompted us to consider the need to revise surgical and nursing management and allocation of resources.…”

Section: Discussionmentioning

confidence: 94%

“…Following are the main elements of the fast-track protocol, as proposed by Kehlet et al 9,10 : preoperative patient education; appropriate discharge planning; limited disruption of fasting period; attenuation of the surgical stress response by minimizing surgical incision and thoracic epidural blockade [11][12][13][14][15] ; optimization of postoperative pain relief by using multimodal analgesia; avoidance or early removal of drains and tubes; and earlier oral feeding and enforced mobilization. These authors have reported a reduction of hospital stay to 2-3 days, low readmission rate, and low morbidity.…”

Section: Résumémentioning

confidence: 99%

See 1 more Smart Citation

An integrated multidisciplinary approach to implementation of a fast-track program for laparoscopic colorectal surgery

Carli

Charlebois

Baldini

et al. 2009

Can J Anesth/J Can Anesth

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Background Enhanced perioperative care programs have been developed in order to attenuate the impact of surgical stress on organ dysfunction, thereby accelerating hospital discharge and reducing morbidity. The implementation of a fast-track program for laparoscopic colorectal surgery is reported. Methods We report on a series of patients who entered a coordinated program based on preoperative patient education and counseling, a laparoscopic approach, provision of postoperative epidural analgesia, early food intake and mobilization, and structured surgical and nursing care practices. The program was introduced in September 2006 and adapted to our institutional needs. Outcome measures included length of hospital stay, return of bowel function, incidences of postoperative complications, and rate of readmission to hospital. Results Twenty-five patients were selected by the surgeons for the accelerated laparoscopic colorectal pathway. The median duration of hospital stay was 3 (95% confidence interval, 3-4) days. Sixteen patients (64%) were discharged from hospital on day 3. Nine patients failed the pathway for various reasons (social indications, poor pain relief, wound infection, anemia, urinary retention) and were discharged later (six patients on day 4, two patients on day 5, and one patient on day 6). Times to recover bowel function and to resume a full diet were all within the first 36 hr from time of surgery. There were two readmissions. Conclusion This early clinical experience demonstrates the feasibility of a fast-track program for colonic surgery and the requirement for an integrated multidisciplinary approach to perioperative care. RésuméContexte Des programmes de soins pe´riope´ratoires ame´liore´s ont e´te´e´labore´s afin d'atte´nuer l'impact du stress chirurgical sur la de´faillance syste´mique, ce qui a permis d'acce´le´rer le conge´de l'hôpital et de re´duire la morbidite´. La mise en oeuvre d'un programme acce´le´re´pour la chirurgie colorectale par laparoscopie est de´crite ici. Méthode Nous pre´sentons une se´rie de patients ayant participe´a`un programme coordonne´et de´crivons la formation et la consultation pre´ope´ratoire des patients, l'approche par laparoscopie, la prestation d'une analge´sie pe´ridurale postope´ratoire, l'absorption de nourriture et la mobilisation pre´coce, et les pratiques structure´es de soins chirurgicaux et infirmiers. Le programme a e´te´mis en place en septembre 2006 et adapte´pour re´pondre aux besoins de notre institution. Nous avons mesure´la dure´e du se´jour a`l'hôpital, la restauration de la fonction intestinale, l'incidence de complications postope´ratoires et le taux de re´admission a`l'hôpital.

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Section: Discussionmentioning

confidence: 94%

Section: Résumémentioning

confidence: 99%

An integrated multidisciplinary approach to implementation of a fast-track program for laparoscopic colorectal surgery

Carli

Charlebois

Baldini

et al. 2009

Can J Anesth/J Can Anesth

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show abstract

“…Zingg et al who studied the influence of TEA on postoperative pain relief and ileus after laparoscopic colorectal resection, he concluded that TEA provides a significant benefit in terms of less analgesic consumption, better postoperative pain relief [24].…”

Section: Resultsmentioning

confidence: 99%

Comparative Study between Continuous Thoracic Epidural vs. Thoracic Spinal Anaesthesia in Breast Surgery

Ahmed¹,

Ali²,

Helal³

et al. 2017

J Pain Relief

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“…First, this ERP did not incorporate several recommended ERP components, as they have only recently been reported. These components include oral carbohydrate loading [35], perioperative intravenous fluid restriction [36], epidural analgesia [37], and avoidance of mechanical bowel preparation (MBP) [38]. The goal-directed fluid management using pulmonary artery catheter or esophageal Doppler was not used in this study.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with failure of enhanced recovery programs after laparoscopic colon cancer surgery: a single-center retrospective study

Ihn

Son

et al. 2015

Surg Endosc

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Influence of thoracic epidural analgesia on postoperative pain relief and ileus after laparoscopic colorectal resection

Abstract: TEA provides a significant benefit in terms of less analgesic consumption, better postoperative pain relief, and faster recovery of gastrointestinal function in patients undergoing laparoscopic colorectal resection.

Cited by 95 publications

References 28 publications

An integrated multidisciplinary approach to implementation of a fast-track program for laparoscopic colorectal surgery

An integrated multidisciplinary approach to implementation of a fast-track program for laparoscopic colorectal surgery

Comparative Study between Continuous Thoracic Epidural vs. Thoracic Spinal Anaesthesia in Breast Surgery

Factors associated with failure of enhanced recovery programs after laparoscopic colon cancer surgery: a single-center retrospective study

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