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Laparoscopy for colectomy accelerates restoration of bowel function when using patient controlled analgesia

[La laparoscopie pour colectomie accélère la restauration de la fonction intestinale quand on utilise l’analgésie autocontrôlée]

Xi Hong, MD^*, Giovanni Mistraletti, MD^*, Shahram Zandi, MD^*, Barry Stein, MD FRSC, Patrick Charlebois, MD FRSC and Franco Carli, MPHIL FRCA FRCPC^*

^* From the Departments of Anesthesia and
Surgery, McGill University Health Centre, Montreal, Quebec, Canada.

Address correspondence to: Dr. Franco Carli, Department of Anesthesia, McGill University Health Centre, 1650 Cedar Avenue, Room D10.144, Montreal, Quebec H3G 1A4, Canada. Phone: 514-934-1934, ext. 43261; Fax: 514-934-8249; E-mail: franco.carli{at}mcgill.ca

Purpose: A standardized care plan incorporating patient-controlled analgesia with iv morphine and a non-accelerated feeding schedule following colectomy was used to compare return of bowel function and hospital discharge times following surgery done by laparoscopy or laparotomy

Methods: Thirty-eight patients were assigned to undergo either laparoscopic or laparotomy colon resection. Postoperative analgesia was achieved with patient-controlled analgesia with iv morphine. General anesthesia and perioperative care were standardized, and a traditional surgical and nursing care program was implemented. Gastrointestinal function (time from surgery to return of passage of flatus and presence of bowel movements), pain intensity (visual analogue scale) at rest, on coughing and on mobilization, amount of morphine used, and criteria for discharge and length of hospital stay were recorded.

Results: Bowel movements resumed earlier in the laparoscopic group (P < 0.05), but not passage of flatus. No significant relationship was found between the amount of morphine used and return of bowel function. Cumulative morphine consumption during the first two postoperative days was similar in both groups. Where a trend towards lower postoperative visual analogue scale scores was observed in the laparoscopic group, visual analogue scale scores on coughing were lower in the laparoscopic vs laparotomy group only during the first 24 hr (P < 0.05). Length of hospital stay was significantly shorter in the laparoscopic group (P < 0.05), although times to meet discharge criteria were similar in both groups.

Conclusions: When patient-controlled analgesia with morphine and a traditional perioperative program are used, a laparoscopic approach to colon surgery promotes earlier restoration of bowel function and more rapid hospital discharge in comparison to resection by laparotomy.

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