Laparoscopy for colectomy accelerates restoration of bowel function when using patient controlled analgesia

Abstract

Purpose: A standardized care plan incorporating patient-controlled analgesia with iv morphine and a non-accelerated feeding schedule following colectomy was used to compare return of bowel function and hospital discharge times following surgery done by laparoscopy or laparotomy. Methods:Thirty-eight patients were assigned to undergo either laparoscopic or laparotomy colon resection. Postoperative analgesia was achieved with patient-controlled analgesia with iv morphine. General anesthesia and perioperative care were standardized, and a traditional surgical and nursing care program was implemented. Gastrointestinal function (time from surgery to return of passage of flatus and presence of bowel movements), pain intensity (visual analogue scale) at rest, on coughing and on mobilization, amount of morphine used, and criteria for discharge and length of hospital stay were recorded.Results: Bowel movements resumed earlier in the laparoscopic group (P < 0.05), but not passage of flatus. No significant relationship was found between the amount of morphine used and return of bowel function. Cumulative morphine consumption during the first two postoperative days was similar in both groups. Where a trend towards lower postoperative visual analogue scale scores was observed in the laparoscopic group, visual analogue scale scores on coughing were lower in the laparoscopic vs laparotomy group only during the first 24 hr (P < 0.05). Length of hospital stay was significantly shorter in the laparoscopic group (P < 0.05), although times to meet discharge criteria were similar in both groups. Conclusions:When patient-controlled analgesia with morphine and a traditional perioperative program are used, a laparoscopic approach to colon surgery promotes earlier restoration of bowel function and more rapid hospital discharge in comparison to resection by laparotomy. Objectif : Un plan de soins normalisé comportant l'analgésie autocontrôlée avec de la morphine iv et un programme d'alimentation

Hospital discharge criteria following colorectal surgery:a systematic review

“…One hundred and fifty‐five studies fulfilled the inclusion criteria (Fig. 1) 6,10,11,13,19–169]. One [31] applied different discharge criteria for each arm of the study.…”

Clinical trial: the impact of cyclooxygenase inhibitors on gastrointestinal recovery after major surgery – a randomized double blind controlled trial of celecoxib or diclofenac vs. placebo

“…Therefore a reduction in narcotic usage in the current study did not underlie the improvement in paralytic ileus rates in the celecoxib group, reinforced by the observation that narcotics had ceased in many patients before paralytic ileus was clinically diagnosed. The significance of reducing narcotic doses to obviate ileus has been questioned 45, 46 but the more detailed, randomized studies relating to Alvimopan, point to narcotics as having a role.…”

Anesthetic and Adjunctive Drugs for Fast-Track Surgery

“…Small doses of lypophylic opioids improve postoperative pain relief but may affect bowel function [272,273]. Minimal invasive surgery decreases surgical stress and the inflammation, resulting in a faster return of bowel function [277]. With regard to postoperative ileus, if the role of epidural analgesia certainly accelerates the recovery of bowel function after open abdominal surgery, its role after laparoscopic surgeries is still controversial [281].…”

“…In the context of fast-track surgery these effects can be maximized only associating multiple interventions such as early feeding and mobilization in order to minimize the untoward postoperative effect of surgical stress thus improving the recovery from surgery [4,14]. Epidural analgesia certainly improves the recovery of bowel function in patients undergoing open colon surgery compared to PCA morphine [277,278], but different results have been reported in patients undergoing laparoscopic colectomy and following a standard perioperative program [279,280]. By adding an accelerated perioperative program which includes thoracic epidural analgesia, the return of bowel function is faster and the hospital length of stay is shorter than patients receiving a standard perioperative care [281,282].…”

“…Therefore, to improve the recovery of postoperative ileus epidural analgesia has to be placed in the mid thoracic region [273,277]. Small doses of lypophylic opioids improve postoperative pain relief but may affect bowel function [272,273].…”