The uptake of laparoscopic colorectal surgery in Great Britain and Ireland: a questionnaire survey of consultant members of the ACPGBI

Schwab, Katie; Dowson, H. M.; Dellen, J. van; Marks, C. G.; Rockall, Timothy

doi:10.1111/j.1463-1318.2008.01601.x

Cited by 66 publications

(57 citation statements)

References 14 publications

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“…Despite the growing popularity of laparoscopic surgery, a significant number of open colorectal resections are still performed in the UK. 5 For over 20 years, epidural infusion analgesia (EIA) has provided superior analgesia compared with systemic analgesia after open colorectal surgery. 6,7 In addition, EIA can effectively suppress surgical stress, reduce the incidence of postoperative pneumonia and shorten postoperative ileus.…”

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confidence: 99%

Rectus sheath catheters provide equivalent analgesia to epidurals following laparotomy for colorectal surgery

Tudor

Yang

Brown

et al. 2015

annals

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INTRODUCTION Rectus sheath catheters (RSCs) are increasingly being used to provide postoperative analgesia following laparotomy for colorectal surgery. Little is known about their efficacy in comparison with epidural infusion analgesia (EIA). They are potentially better as they avoid the recognised complications associated with EIA. This study compares these two methods of analgesia. Outcomes include average pain scores, time to mobilisation and length of stay. METHODS This was a 33-month single centre observational study including all patients undergoing elective open or laparoscopic-converted-to-open colorectal resection for both benign and malignant disease. Patients received either EIA or RSCs. Data were collected prospectively and analysed retrospectively. RESULTS A total of 95 patients were identified. Indications for surgery, operation and complications were recorded. The mean time to mobilisation was significantly shorter in patients who had RSCs compared with EIA patients (2.4 vs 3.5 days, p<0.05). There was no difference in postoperative pain scores or length of stay. CONCLUSIONS RSCs provide equivalent analgesia to EIA and avoid the recognised potential complications of EIA. They are associated with a shorter time to mobilisation. Their use should be adopted more widely.

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mentioning

confidence: 99%

Rectus sheath catheters provide equivalent analgesia to epidurals following laparotomy for colorectal surgery

Tudor

Yang

Brown

et al. 2015

annals

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“…Nevertheless, a substantial proportion of surgery remains open. 1 The accepted 'gold standard' technique for postoperative analgesia following open colorectal surgery is epidural analgesia (EA). 2 The use of EA provides effective analgesia, and has the benefits of reducing systemic opiate requirements, ileus and pulmonary complications.…”

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confidence: 99%

Ultrasonography guided rectus sheath catheters versus epidural analgesia for open colorectal cancer surgery in a single centre

Godden

Marshall

Grice

et al. 2013

Ann R Coll Surg Engl

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However, it is not without significant risk. This study aimed to audit the effect of EA and ultrasonography placed rectus sheath catheters (RSCs) on analgesia as well as the incidence of postoperative complications following open colorectal cancer surgery. METHODS A three-year retrospective case note review was undertaken of all patients undergoing open colorectal cancer surgery at the Royal Devon and Exeter Hospital NHS Foundation Trust who received either EA or RSC for postoperative analgesia under the care of the senior authors. A single surgeon and single anaesthetist were practitioners. RESULTS The case notes of 120 patients were reviewed retrospectively: 85 patients had EA and 24 RSC while 11 patients were excluded from the study. The EA group experienced a significantly higher incidence of hypotension (systolic blood pressure <130mmHg) than the RSC group on the first postoperative day (p=0.0001). There was no significant difference in pain score or opiate sparing properties between the groups (p=0.92). There was no significant difference in postoperative respiratory tract infection, anastomotic leak or wound complications between the groups (p=0.2, p=1.0 and p=0.5 respectively). The RSC group had a higher incidence of ileus than the EA group (4/24 vs 2/85, p=0.026). However, the numbers were too small to draw a reliable conclusion. CONCLUSIONS The use of ultrasonography guided RSCs has demonstrated effective postoperative analgesia equivalent to EA with the potential benefits of a reduced incidence of hypotension. A prospective randomised trial is now underway to compare RSC and EA in open abdominal and pelvic surgery.In the UK, laparoscopic colorectal surgery is increasing. Nevertheless, a substantial proportion of surgery remains open.1 The accepted 'gold standard' technique for postoperative analgesia following open colorectal surgery is epidural analgesia (EA).2 The use of EA provides effective analgesia, and has the benefits of reducing systemic opiate requirements, ileus and pulmonary complications.3,4 Epidurals have reported complications that range from superficial wound site infection to paraplegia. 5-8The introduction of local nerve blocks in place of EA in open colorectal surgery has shown promising results.9,10 The use of regional blocks has been shown to provide effective postoperative analgesia and demonstrates opiate sparing properties. Furthermore, it has been shown to be safe and avoids the risk for potentially devastating complications of EA. Associated complications with the use of regional blocks include insufficient block, local anaesthetic toxicity and visceral puncture. However, the safety margin can be improved by the use of ultrasonography to guide insertion.11 A study looking at the opiate sparing effects of regional block (transverse abdominis plane) for right hemicolectomies has produced promising results. 12We aim to add to this body of evidence and expand on it by describing the analgesic effect of ultrasonography guided rectus sheath catheters (RSCs) compared with EA in op...

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“…Keywords Single-incision laparoscopic surgery Á Total abdominal colectomy Á Ulcerative colitis More than 20 years after the description of the first laparoscopic colectomy, laparoscopic surgery has slowly gained wide acceptance for the treatment of colorectal diseases based on the evidence provided by clinical randomized trials and meta-analyses that showed several advantages in terms of short-term outcomes over open surgery, with comparable safety and long-term results [1][2][3][4][5][6]. Over time, laparoscopy has become the modality of choice in our practice for surgical treatment of ulcerative colitis (UC).…”

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confidence: 99%

Single-incision laparoscopic total abdominal colectomy for refractory ulcerative colitis

Fichera

Zoccali

2011

Surg Endosc

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The uptake of laparoscopic colorectal surgery in Great Britain and Ireland: a questionnaire survey of consultant members of the ACPGBI

Abstract: Laparoscopic colorectal surgery is being performed by more than half (53%) of colorectal consultants nationwide, although only a quarter of all procedures are being undertaken laparoscopically.

Cited by 66 publications

References 14 publications

Rectus sheath catheters provide equivalent analgesia to epidurals following laparotomy for colorectal surgery

Rectus sheath catheters provide equivalent analgesia to epidurals following laparotomy for colorectal surgery

Ultrasonography guided rectus sheath catheters versus epidural analgesia for open colorectal cancer surgery in a single centre

Single-incision laparoscopic total abdominal colectomy for refractory ulcerative colitis

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