Epidural injection of extended-release morphine during colorectal surgery.

See Article on Page 186-191

Postoperative pain is one of the most serious symptoms in cancer patients. However, many patients receive inadequate pain management despite the existence of established pain treatment guidelines [1]. Normally, pain is not a surgeon's primary concern [2]. However, with enhanced recovery programs and laparoscopic surgery, optimal pain management is a key factor in postoperative care and leads to an improvement in physical performance and pulmonary functions and to a decrease in the length of the hospital stay [3].

Until recently, the optimal duration or route for pain control was not considered during randomized trials [4] and still remains a controversial issue. Peravali described a case series of 280 patients who had undergone open and laparoscopic colorectal procedures under a single epidural injection of extended-release morphine, DepoDur® [5]. These patients had neither an epidural catheter nor an epidural infusion pump. In addition, approximately 30% of all patients did not require any additional opiate analgesia, and only 12% required patient-controlled analgesia at 48 hours [5]. DepoDur® has been used in various orthopedic, obstetric, and gynecological studies, which have demonstrated effective long-lasting analgesia in the absence of large concentrations of opioids, as well as enhanced patient activity levels and satisfaction [6, 7, 8]. To our knowledge, this is the largest case series reporting the use of DepoDur® in colorectal surgery.

Peravali did not make direct comparisons with traditional epidural infusions or postoperative analgesics. However, these case 2014.30.4.159series did highlight the advantages of extended-release epidural morphine with tolerable side effects, such as transient hypotension, respiratory compromise, pruritus, and nausea, in the context of colorectal surgery [9]. This prospective study provides an innovative technique for pain management in order to improve the outcomes of postoperative care in colorectal cancer patients and provides encouraging data that justify randomized controlled trails.