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Randomized clinical trial comparing epidural anaesthesia and patient-controlled analgesia after laparoscopic segmental colectomy

Authors

  • A. J. Senagore,

    Corresponding author
    1. Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
    2. Minimally Invasive Surgery Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
    • Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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  • C. P. Delaney,

    1. Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
    2. Minimally Invasive Surgery Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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  • N. Mekhail,

    1. Pain Management Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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  • A. Dugan,

    1. Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
    2. Minimally Invasive Surgery Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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  • V. W. Fazio

    1. Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Abstract

Background

This randomized clinical trial compared the use of thoracic epidural anaesthesia–analgesia (TEA) with morphine patient-controlled analgesia (PCA) for pain relief after laparoscopic colectomy.

Methods

Patients scheduled for segmental laparoscopic colectomy were randomized to receive TEA or PCA. Patients in the TEA group received bupivacaine and fentanyl before incision and after surgery by continuous infusion for 18 h. Patients in the PCA group self-administered morphine using an intravenous pump. The postoperative care plan was otherwise identical for the two groups. Postoperative pain was measured during ambulation using a visual analogue pain score.

Results

The study included 38 patients (18 TEA, 20 PCA), 16 of whom underwent right hemicolectomy or ileocolectomy and 22 sigmoid colectomy. Operating times, patient weight and distribution of American Society of Anesthesiologists grade were similar in the two groups. The mean(s.e.m.) total dose of drugs administered was 64(41) mg morphine in the PCA group, and 79(42) mg bupivacaine and 205(140) µg fentanyl in the TEA group. Postoperative pain scores were significantly better in the TEA group at 6 h (mean(s.e.m.) 2·2(0·4) versus 6·6(0·5) with PCA; P = 0·001) and 18 h (2·2(0·3) versus 4·0(0·4); P = 0·003). Hospital stay was similar in the two groups.

Conclusion

TEA significantly improved early analgesia following laparoscopic colectomy but did not affect the length of hospital stay. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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