Jin Sun Cho1,2, Hyoung-Il Kim3, Ki-Young Lee1,2, Taeil Son3, Sun Joon Bai1,2, Haegi Choi1, Young Chul Yoo4,5. 1. Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea. 2. Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea. 3. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. 4. Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea. seaoyster@yuhs.ac. 5. Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea. seaoyster@yuhs.ac.
Abstract
BACKGROUND: Although laparoscopic surgery significantly reduces surgical trauma compared to open surgery, postoperative ileus is a frequent and significant complication after abdominal surgery. Unlike laparoscopic colorectal surgery, the effects of epidural analgesia on postoperative recoveryafter laparoscopic gastrectomy are not well established. We compared the effects of epidural analgesia to those of conventional intravenous (IV) analgesia on the recovery of bowel functionafter laparoscopic gastrectomy. METHOD:Eighty-six patients undergoinglaparoscopic gastrectomy randomly received either patient-controlled epidural analgesia with ropivacaine and fentanyl (Epi PCA group) or patient-controlled IV analgesia with fentanyl (IV PCA group), beginning immediately before incision and continuing for 48 h thereafter. The primary endpoint was recovery of bowel function, evaluated by the time to first flatus. The balance of the autonomic nervous system, pain scores, duration of postoperative hospital stay, and complications were assessed. RESULTS: The time to first flatus was shorter in the epidural PCA group compared with the IV PCA group (61.3 ± 11.1 vs. 70.0 ± 12.3 h, P = 0.001). Low-frequency/high-frequency power ratios during surgery were significantly higher in the IV PCA group, compared with baseline and those in the epidural PCA group. The epidural PCA group had lower pain scores during the first 1 h postoperatively and required less analgesics during the first 6 h postoperatively. CONCLUSIONS: Compared with IV PCA, epidural PCA facilitated postoperative recovery of bowel functionafter laparoscopic gastrectomy without increasing the length of hospital stay or PCA-related complications. This beneficial effect of epidural analgesia might be attributed to attenuation of sympathetic hyperactivation, improved analgesia, and reduced opioid use.
RCT Entities:
BACKGROUND: Although laparoscopic surgery significantly reduces surgical trauma compared to open surgery, postoperative ileus is a frequent and significant complication after abdominal surgery. Unlike laparoscopic colorectal surgery, the effects of epidural analgesia on postoperative recovery after laparoscopic gastrectomy are not well established. We compared the effects of epidural analgesia to those of conventional intravenous (IV) analgesia on the recovery of bowel function after laparoscopic gastrectomy. METHOD: Eighty-six patients undergoing laparoscopic gastrectomy randomly received either patient-controlled epidural analgesia with ropivacaine and fentanyl (Epi PCA group) or patient-controlled IV analgesia with fentanyl (IV PCA group), beginning immediately before incision and continuing for 48 h thereafter. The primary endpoint was recovery of bowel function, evaluated by the time to first flatus. The balance of the autonomic nervous system, pain scores, duration of postoperative hospital stay, and complications were assessed. RESULTS: The time to first flatus was shorter in the epidural PCA group compared with the IV PCA group (61.3 ± 11.1 vs. 70.0 ± 12.3 h, P = 0.001). Low-frequency/high-frequency power ratios during surgery were significantly higher in the IV PCA group, compared with baseline and those in the epidural PCA group. The epidural PCA group had lower pain scores during the first 1 h postoperatively and required less analgesics during the first 6 h postoperatively. CONCLUSIONS: Compared with IV PCA, epidural PCA facilitated postoperative recovery of bowel function after laparoscopic gastrectomy without increasing the length of hospital stay or PCA-related complications. This beneficial effect of epidural analgesia might be attributed to attenuation of sympathetic hyperactivation, improved analgesia, and reduced opioid use.
Authors: Jin Sun Cho; Hyoung-Il Kim; Ki-Young Lee; Ji Yeong An; Sun Joon Bai; Ju Yeon Cho; Young Chul Yoo Journal: Medicine (Baltimore) Date: 2015-06 Impact factor: 1.889
Authors: Eun-Heui Jin; Sang-Il Lee; JaeWoo Kim; Eun Young Seo; Su Yel Lee; Gang Min Hur; Sanghee Shin; Jang Hee Hong Journal: J Korean Med Sci Date: 2015-07-15 Impact factor: 2.153
Authors: Stephanie S Kim; Xiaojuan Niu; Irmina A Elliott; Jerry P Jiang; Amanda M Dann; Lauren M Damato; Hallie Chung; Mark D Girgis; Jonathan C King; O Joe Hines; Siamak Rahman; Timothy R Donahue Journal: Pancreas Date: 2019 May/Jun Impact factor: 3.327