Thoracic epidural analgesia facilitates the restoration of bowel function and dietary intake in patients undergoing laparoscopic colon resection using a traditional, nonaccelerated, perioperative care program

Taqi, Arshad; Hong, Xi; Mistraletti, Giovanni; Stein, Barry S.; Charlebois, Patrick; Carli, Franco

doi:10.1007/s00464-006-0069-5

Cited by 99 publications

(81 citation statements)

References 23 publications

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“…Our findings are consistent with the previous studies showing an analgesic benefit with the use of TEA. 6,7 We have also confirmed Taqi et al's findings that improved analgesia can be achieved with lower opiate dose analgesia it has been difficult to demonstrate an improvement in overall patient outcome with regard length of hospital stay. Attention has increasingly turned to improving quality of recovery and a return to normal level of functioning.…”

Section: Discussionsupporting

confidence: 82%

“…There is evidence of similar improved outcomes with the use TEA in laparoscopic colectomy with a reduction in hospital stay 6 and accelerated return of bowel function and dietary intake. 7 However in our study the improved pain scores of the TEA group within the first 24 hours did not translate into a reduction in length of hospital stay (5 [4][5] vs 4 [3.3-6.8] days). This may be due to the small numbers in our study as the markedly higher mean pain scores within the PCA group (4.4-5.9 vs. 0-1.3) would be expected to reduce respiratory function and the patient's ability to mobilize.…”

Section: Resultscontrasting

confidence: 71%

“…One further study has shown improved analgesia in the first 48 hours after surgery with TEA using lower opiate dosages. 7 This paper reports our experience of TEA vs PCA in the management of patients following laparoscopic colectomy.…”

Section: Introductionmentioning

confidence: 99%

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Thoracic Epidural versus Morphine Patient Controlled Analgesia After Laparoscopic Colectomy

Dennis¹,

Mills²

2008

WJOLS

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Despite the benefits of the laparoscopic approach to colorectal surgery patients still experience significant levels of pain post-operatively. This study aimed to compare the use of thoracic epidural vs. morphine patient controlled analgesia in the management of pain after laparoscopic colorectal surgery. A retrospective analysis of hospital records was performed for 16 patients undergoing laparoscopic colorectal surgery (8 thoracic

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Section: Discussionsupporting

confidence: 82%

Section: Resultscontrasting

confidence: 71%

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Thoracic Epidural versus Morphine Patient Controlled Analgesia After Laparoscopic Colectomy

Dennis¹,

Mills²

2008

WJOLS

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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: 91%

“…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%

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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Epidural Analgesia in Laparoscopic Colorectal Surgery

et al. 2014

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Thoracic epidural analgesia facilitates the restoration of bowel function and dietary intake in patients undergoing laparoscopic colon resection using a traditional, nonaccelerated, perioperative care program

Abstract: When a traditional perioperative care program is used for laparoscopic colectomy, thoracic epidural analgesia is superior to PCA in accelerating the return of bowel function and dietary intake, while providing better pain relief.

Cited by 99 publications

References 23 publications

Thoracic Epidural versus Morphine Patient Controlled Analgesia After Laparoscopic Colectomy

Thoracic Epidural versus Morphine Patient Controlled Analgesia After Laparoscopic Colectomy

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

Epidural Analgesia in Laparoscopic Colorectal Surgery

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