Influence of postoperative epidural analgesia on postoperative rehabilitation in major digestive surgery – a comparative study

Ioana Grigoraş, Celina Carteş, Mihaela Lechinţeanu, C. Săndulache, M. Borcea, Oana Onofrei

Universitatea de Medicină şi Farmacie Iaşi
Clinica Anestezie-Terapie Intensivă
Spitalul Clinic Universitar de Urgenţă „Sf. Spiridon”, Iaşi

Abstract

Goal: The study was performed in order to evaluate the efficacy and advantages of epidural analgesia in comparison with intravenous analgesia on postoperative rehabilitation in patients with major digestive surgery. Postoperative rehabilitation was assessed as need for postoperative ventilatory support, active mobilization and return of bowel movements.

Method: The prospective nonrandomized controlled study enrolled 85 patients (56.8% over 65 years) divided into two groups: group P (44 patients) who received postoperative epidural analgesia (continuous administration of 0.125% levobupivacaine) and group M (41 patients) who received intravenous analgesia (opioids and nonopioids). In both groups in case of a VAS pain score ≥ 4, supplemental i.v. analgesia was given as an endpoint the pain score ≤ 3. Recorded data: quality of analgesia (pain score), analgesic administration (dose of local anesthetic, supplemental requirements of analgesics), postoperative evolution (need/duration of postoperative ventilatory support, day of active mobilization, day of first flatus). Success rate of catheter insertion and complications were recorded in group P.

Results: There were no significant differences between groups regarding age, malignancy incidence, type of surgical procedure and ASA score (p = 0.48-0.82). The mean pain score was significantly lower in group P (2.29 ± 1.0) compared with group M (3.87 ± 0.8) (p < 0,001). Patients over 65 years with epidural analgesia had a lower incidence of postoperative ventilatory support compared with group M (p = 0.017). In group P active mobilization and first flatus were recorded earlier then in group M (p = 0.03, respectively p < 0.001). Success rate of epidural catheter insertion was 63.7% (44 patients, group P) and complications were transient.

Conclusions: Epidural analgesia with local anesthetics offers important benefits compared with intravenous analgesia in major digestive surgery, especially in elderly patients: better efficacy and enhanced postoperative rehabilitation.

Keywords: pain, epidural analgesia, opioids, major digestive surgery, postoperative rehabilitation