Abstract
Background. Aggressive postoperative care plans after open colectomy may allow earlier discharge,
especially in conjunction with preoperative thoracic epidural anesthesia-analgesia
using a local anesthetic and narcotic. The purpose of this study was to evaluate the
role of thoracic epidural anesthesia-analgesia using bupivacaine and fentanyl citrate
in reducing lengths of stay after laparoscopic colectomy (LAC). Methods. A consecutive cohort of patients who underwent LAC and who received perioperative
thoracic epidural anesthesia-analgesia (TEG) was compared with a standard group of
patients (STD) undergoing LAC during the 2 months preceding the implementation of
the epidural management protocol. Patients with TEG received 6 to 8 mL bupivacaine
(0.25%) and fentanyl citrate (100 μg) through a T8-9 or a T9-10 epidural catheter
before the incision was made and a postoperative infusion of bupivacaine (0.1%) and
fentanyl citrate (5 μg/mL) at 4 to 6 mL/h for 18 hours. STD patients had supplemental
intravenous morphine. The postoperative care plan was otherwise identical between
the 2 groups. Patients were matched by sex, age, and type of segmental resection.
Discharge criteria included tolerance of 3 general diet meals, passage of flatus or
stool, and adequate oral analgesia. Length of stay was defined as the time from admission
for the surgical procedure to discharge from the hospital. Statistical analysis included
a Student t test, Wilcoxon rank sum test, chi-square trend test, and Fisher exact
test where appropriate. Data are presented as mean ± SEM. Results. Procedures performed were: right hemicolectomy-ileocolectomy (TEG, n = 5; STD, n
= 5); or sigmoid colectomy-rectopexy (TEG, n = 17; STD, n = 17). There was no significant
difference with respect to operating room (OR) time (TEG, 102 ± 12 minutes; STD, 87
± 17 minutes), body mass index (TEG, 26 ± 2; STD, 26 ± 2), or American Society of
Anesthesiologists class (I-III) distribution (TEG, 3/12/10; STD, 4/11/7), or mean
incision length (TEG, 3.5 ± 0.4 cm; STD, 3.7 ± 0.3 cm.) No postoperative complications
or readmissions occurred in either group. The length of stay decreased in the TEG
group (TEG, 2.8 ± 0.2 days; STD, 3.9 ± 0.3; P <.001) and the median length of stay
for the 2 groups was similarly less (TEG, 2 days; STD, 3 days). Conclusions. These data suggest that thoracic epidural anesthesia-analgesia has a significant
and favorable impact on dietary tolerance and length of stay after LAC. A thoracic
epidural appears to be an important component of a postoperative care protocol, which
adds further advantage to LAC without the need for labor-intensive and costly patient
care plans. (Surgery 2001;129:672-6.)
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Article info
Publication history
Accepted:
January 27,
2000
Footnotes
*Reprint requests: Reprints not available from the author.
**Surgery 2001;129:672-6.
Identification
Copyright
© 2001 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
