Stefano Turi1, Marco Gemma2, Marco Braga3, Roberta Monzani4, Danilo Radrizzani5, Luigi Beretta6. 1. Department of Anesthesiology, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy. turi.stefano@hsr.it. 2. Anesthesia and Intensive Care Unit-Fatebenefratelli Hospital, Piazzale Principessa Clotilde, 20121, Milano, Italy. 3. Department of Surgery-San Gerardo Hospital, Milano-Bicocca University, Milano, Italy. 4. Department of Anesthesia, Humanitas Research Hospital, Rozzano, Milano, Italy. 5. Department of Anesthesia, Legnano Hospital, Milan, Italy. 6. Department of Anesthesiology, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy.
Abstract
PURPOSE: A well-controlled pain is one of the most important targets of enhanced recovery after surgery (ERAS) protocols. Recent studies questioned the role of TEA (thoracic epidural analgesia) in support of less invasive techniques, in particular in laparoscopic mini-invasive surgery. The aim of this study is to compare patients undergoing laparoscopic mini-invasive colorectal surgery and receiving different analgesic techniques. METHODS: Prospectively collected data entered in the electronic registry of POIS (Perioperative Italian Society) specifically designed for ERAS were reviewed. Patients undergoing colorectal laparoscopic surgery were divided in two groups according to TEA or parenteral opioid administration. In comparing TEA and opioid groups, propensity score weights were obtained. Postoperative pain control and time to readiness for discharge (TRD) were considered as primary endpoints of the study. Secondary endpoints were postoperative morbidity, PONV (postoperative nausea and vomiting), hours of mobilization, length of hospital stay (LOS), timing of fluid and solid re-assumption, and recovery of bowel function. RESULTS: Fourteen Italian hospitals reported data on 560 patients (283 TEA, 277 opioid group). Patients of the opioid group were able to mobilize for a longer period than TEA group patients but presented a higher incidence of PONV. Pain intensity and TRD were similar in both groups. LOS was significantly reduced in TEA patients; also, this result was clinically irrelevant (5.7 ± 3.21 days TEA group vs 5.8 ± 2.92 opioid group). CONCLUSION: In patients undergoing laparoscopic colorectal surgery, TEA was not associated to a better pain control or to an improvement in postoperative outcome compared with opioid administration.
PURPOSE: A well-controlled pain is one of the most important targets of enhanced recovery after surgery (ERAS) protocols. Recent studies questioned the role of TEA (thoracic epidural analgesia) in support of less invasive techniques, in particular in laparoscopic mini-invasive surgery. The aim of this study is to compare patients undergoing laparoscopic mini-invasive colorectal surgery and receiving different analgesic techniques. METHODS: Prospectively collected data entered in the electronic registry of POIS (Perioperative Italian Society) specifically designed for ERAS were reviewed. Patients undergoing colorectal laparoscopic surgery were divided in two groups according to TEA or parenteral opioid administration. In comparing TEA and opioid groups, propensity score weights were obtained. Postoperative pain control and time to readiness for discharge (TRD) were considered as primary endpoints of the study. Secondary endpoints were postoperative morbidity, PONV (postoperative nausea and vomiting), hours of mobilization, length of hospital stay (LOS), timing of fluid and solid re-assumption, and recovery of bowel function. RESULTS: Fourteen Italian hospitals reported data on 560 patients (283 TEA, 277 opioid group). Patients of the opioid group were able to mobilize for a longer period than TEA group patients but presented a higher incidence of PONV. Pain intensity and TRD were similar in both groups. LOS was significantly reduced in TEApatients; also, this result was clinically irrelevant (5.7 ± 3.21 days TEA group vs 5.8 ± 2.92 opioid group). CONCLUSION: In patients undergoing laparoscopic colorectal surgery, TEA was not associated to a better pain control or to an improvement in postoperative outcome compared with opioid administration.
Authors: Stefano Turi; Francesco Deni; Gaetano Lombardi; Marilena Marmiere; Francesco Giuseppe Nisi; Luigi Beretta Journal: J Pain Res Date: 2019-07-26 Impact factor: 3.133