View in EDS

Comparison of the effects of patient-controlled epidural and intravenous analgesia on postoperative bowel function after laparoscopic gastrectomy: a prospective randomized study

Saved in:
Bibliographic Details
Title: Comparison of the effects of patient-controlled epidural and intravenous analgesia on postoperative bowel function after laparoscopic gastrectomy: a prospective randomized study
Authors: Ki-Young Lee, Taeil Son, Jin Sun Cho, Sun Joon Bai, Hyoung Il Kim, Haegi Choi, Young Chul Yoo
Contributors: College of Medicine, Dept. of Surgery, Jin Sun Cho, Hyoung-Il Kim, Ki-Young Lee, Taeil Son, Sun Joon Bai, Haegi Choi, Young Chul Yoo, Kim, Hyoung Il, Bai, Sun Joon, Son, Tae Il, Yoo, Young Chul, Lee, Ki Young, Cho, Jin Sun
Source: Surgical Endoscopy. 31:4688-4696
Publisher Information: Springer Science and Business Media LLC, 2017.
Publication Year: 2017
Subject Terms: Male, Epidural analgesia, Local/administration & dosage, Amides/adverse effects, Epidural/adverse effects, Laparoscopy/methods, 0302 clinical medicine, Prospective Studies, Anesthetics, Local, Ileus/chemically induced, Defecation, Patient-Controlled/methods, Epidural/methods, Analgesics, Pain, Postoperative, Middle Aged, 3. Good health, Analgesia, Epidural, Analgesics, Opioid, Fentanyl, Length of Stay/statistics & numerical data, Administration, Gastrectomy/methods, Laparoscopic gastrectomy, Patient-Controlled/adverse effects, Administration, Intravenous, Female, Opioid/adverse effects, Ileus/epidemiology, Intravenous, Gastrectomy/adverse effects, Adult, Amides/administration & dosage, Pain, Fentanyl/adverse effects, 03 medical and health sciences, Ileus, Gastrectomy, Humans, Pain Management, Opioid/administration & dosage, Heart rate variability, Anesthetics, Aged, Local/adverse effects, Fentanyl/administration & dosage, Analgesia, Patient-Controlled, Laparoscopy/adverse effects, Length of Stay, Amides, Postoperative/drug therapy, Recovery of Function/drug effects, Laparoscopy, Analgesia
Description: 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.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.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.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.
Document Type: Article
Language: English
ISSN: 1432-2218
0930-2794
DOI: 10.1007/s00464-017-5537-6
Access URL: https://pubmed.ncbi.nlm.nih.gov/28389801
https://ir.ymlib.yonsei.ac.kr/handle/22282913/161295
https://pubmed.ncbi.nlm.nih.gov/28389801/
https://link.springer.com/article/10.1007/s00464-017-5537-6
https://www.ncbi.nlm.nih.gov/pubmed/28389801
Rights: Springer TDM
CC BY NC ND
Accession Number: edsair.doi.dedup.....fdc0108c9a6e903917ff976780c37cdb
Database: OpenAIRE
Description
Abstract: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.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.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.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.
ISSN:14322218
09302794
DOI:10.1007/s00464-017-5537-6