A new study in the March issue of Anesthesiology suggests epidural analgesia (EA) may be a more effective component in the perioperative care of patients undergoing elective open colorectal surgery than the proposed alternative, continuous wound infiltration of local anesthetics (CWI).
Effective postoperative analgesia allowing early mobilization is an essential component of fast-track anesthesia and surgery programs. While EA can provide such effective analgesia after colorectal surgery, CWI has been proposed as an alternative because it could be cheaper and simpler to use.
A team of anesthesiologists from the University Hospital of Clermont-Ferrand in France compared both EA and CWI in a randomized, double blind controlled trial of patients undergoing colorectal surgery. Findings showed EA produced better patient outcomes including an increase in postoperative pain relief, faster functional recovery and shorter hospital stays than CWI.
The study treated fifty patients with either EA or CWI for 48 hours. In both groups, patients were managed according to the Enhanced Recovery After Surgery (ERAS) program, based on the principle that reducing the body's stress response after surgery reduces the time needed to recuperate. Patients' pain scores were measured 24 hours after surgery using a 100-mm verbal numerical scale.
"We knew CWI was seen as an attractive solution for pain care in abdominal surgery recovery, but it hadn't been directly compared to the tried-and-true epidural method for colorectal surgery patients," said study author Emmanuel Futier, M.D. "Unlike after abdominal surgery, our study found EA was the superior choice after colorectal surgery."
The findings suggest the added cost and complexity of EA are worth it to provide the best form of pain relief for colorectal surgery patients.
American Society of Anesthesiologists