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A RANDOMIZED STUDY ON THE EFFECT OF EPIDURAL ANESTHESIA ON BOWEL MOTILITY

Departments of Anesthesia, Surgery and Clinical Epidemiology, McGill University Health Center, 687 Pine Ave West, Montreal, Quebec, Canada, H3A1A1

INTRODUCTION

The purpose of this prospective, randomized study was to determine whether continuous thoracic epidural anesthesia and analgesia influences the duration of postoperative ileus after colonic surgery under standardized controlled postoperative care.

METHODS

With approval of the local research ethics committee, sixty-four patients scheduled for elective colonic resection were studied. They were assigned to two groups, a control group (n=32) receiving general anesthesia and postoperative patient controlled analgesia (PCA) with i.v. morphine, and a treatment group (n=32) receiving thoracic epidural blockade with bupivacaine and general anesthesia followed by postoperative continuous epidural analgesia with bupivacaine and fentanyl. All patients received nonsteroidal anti-inflammatory drugs, and were offered a light diet and assisted mobilization from postoperative day one. The following data were recorded during the postoperative period: visual analogue scale (VAS) at rest and on coughing, time intervals from surgery to first flatus and first bowel movement, readiness for discharge (RFD) and length of hospital stay (LOS).

RESULTS

The two groups were comparable for age, operating time and intraoperative care. VAS at rest and on coughing, during the first 4 postoperative days, was significantly greater in the control group compared with the treatment group (p<0.01). First passage of flatus and first bowel movement occurred during the second postoperative day in over 60% and 40% of patients respectively receiving epidural analgesia compared with 26% and 3.3% of patients receiving PCA (p<0.01). Average (SD) RDF was 5.5 days (1.2) in the control group and 4.3 days (1.4) in the treatment group (p<0.05). LOS was 9.2 days (4.0) in the control group and 8 days (3.8) in the treatment group (NS).

DISCUSSION

Thoracic epidural anesthesia and analgesia is highly effective in restoring bowel motility after surgery and provides superior pain relief in comparison with PCA morphine. However, discharge home was not faster, implying that other factors influence the duration of hospital stay.

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