PMID- 11391364
OWN - NLM
STAT- MEDLINE
DCOM- 20010621
LR  - 20041117
IS  - 0039-6060 (Print)
IS  - 0039-6060 (Linking)
VI  - 129
IP  - 6
DP  - 2001 Jun
TI  - Epidural anesthesia-analgesia shortens length of stay after laparoscopic 
      segmental colectomy for benign pathology.
PG  - 672-6
AB  - 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 microg) 
      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 microg/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.
FAU - Senagore, A J
AU  - Senagore AJ
AD  - Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
FAU - Whalley, D
AU  - Whalley D
FAU - Delaney, C P
AU  - Delaney CP
FAU - Mekhail, N
AU  - Mekhail N
FAU - Duepree, H J
AU  - Duepree HJ
FAU - Fazio, V W
AU  - Fazio VW
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Surgery
JT  - Surgery
JID - 0417347
SB  - IM
MH  - *Analgesia, Epidural
MH  - *Anesthesia, Epidural
MH  - *Colectomy
MH  - Humans
MH  - Laparoscopy
MH  - *Length of Stay
EDAT- 2001/06/08 10:00
MHDA- 2001/06/22 10:01
CRDT- 2001/06/08 10:00
PHST- 2001/06/08 10:00 [pubmed]
PHST- 2001/06/22 10:01 [medline]
PHST- 2001/06/08 10:00 [entrez]
AID - S0039-6060(01)06074-3 [pii]
AID - 10.1067/msy.2001.114648 [doi]
PST - ppublish
SO  - Surgery. 2001 Jun;129(6):672-6. doi: 10.1067/msy.2001.114648.