Abstract
IntroductionEpidural analgesia has demonstrated superiority over conventional analgesia in controlling pain following open colorectal resections. Controversy exists regarding cost-effectiveness and postoperative outcomes. MethodsThe Nationwide Inpatient Sample (2002–2010) was retrospectively reviewed for elective open colorectal surgeries performed for benign and malignant conditions with or without the use of epidural analgesia. Multivariate regression analysis was used to compare outcomes between epidural and conventional analgesia. ResultsA total 888,135 patients underwent open colorectal resections. Epidural analgesia was only used in 39,345 (4.4 %) cases. Epidurals were more likely to be used in teaching hospitals and rectal cancer cases. On multivariate analysis, in colonic cases, epidural analgesia lowered hospital charges by US$4,450 (p < 0.001) but was associated with longer length of stay by 0.16 day (p < 0.05) and a higher incidence of ileus (OR = 1.17; p < 0.01). In rectal cases, epidural analgesia was again associated with lower hospital charges by US$4,340 (p < 0.001) but had no effect on ileus and length of stay. The remaining outcomes such as mortality, respiratory failure, pneumonia, anastomotic leak, urinary tract infection, and retention were unaffected by the use of epidurals. ConclusionEpidural analgesia in open colorectal surgery is safe but does not add major clinical benefits over conventional analgesia. It appears however to lower hospital charges.
Highlights
Epidural analgesia has demonstrated superiority over conventional analgesia in controlling pain following open colorectal resections
Because of its sympatholytic effect on spinal reflex mechanism,[3] its anti-inflammatory activity, and its potential to reduce postsurgical stress response,[4,5] epidural analgesia in open colorectal surgery has been suggested to shorten postoperative ileus,[3,4] increase the blood flow to the intestine thereby contributing to the healing of intestinal anastomosis,[6] reduce the incidence of major complications,[5] and reduce 30-day mortality.[7]
A prospective non-randomized study comparing different methods of perioperative analgesia found that Epidural analgesia (EA) was less costly compared to intravenous patient controlled analgesia (IV PCA) in patients undergoing major intraabdominal surgery.[20]
Summary
Epidural analgesia has demonstrated superiority over conventional analgesia in controlling pain following open colorectal resections. Because of its sympatholytic effect on spinal reflex mechanism,[3] its anti-inflammatory activity, and its potential to reduce postsurgical stress response,[4,5] epidural analgesia in open colorectal surgery has been suggested to shorten postoperative ileus,[3,4] increase the blood flow to the intestine thereby contributing to the healing of intestinal anastomosis,[6] reduce the incidence of major complications,[5] and reduce 30-day mortality.[7] because of its superior pain control, EA may be associated with lower incidences of pulmonary complications.[8]. J Gastrointest Surg (2013) 17:1130–1137 of epidural analgesia has been analyzed in patients undergoing thoracic and upper and lower abdominal surgery without controlling for this heterogeneity.[8] because of the increased adoption of laparoscopic techniques in colorectal surgery,[9] recent reports have been focusing on the outcomes of EA following laparoscopic resections. Many of these published series come from tertiary care centers which have specialized teams in the placement and management of epidural catheters
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