Abstract and Introduction
Abstract
Background This study was undertaken to determine the impact of an intrathecal mixture of bupivacaine and morphine, when compared with systemic morphine, on the quality of postoperative analgesia and other outcomes in the context of the enhanced recovery after surgery (ERAS) programme for laparoscopic colonic resection.
Methods Fifty patients undergoing general anaesthesia were randomly allocated to receive either a spinal mixture of bupivacaine and morphine followed by oral oxycodone (spinal group) or patient-controlled analgesia (PCA group). The primary outcome was consumption of opioids during the first three postoperative days. Secondary outcomes were pain scores, return of bowel function and dietary intake, readiness to hospital discharge, and length of hospital stay.
Results Postoperative opioid consumption in the spinal group was significantly less over the first three postoperative days (P<0.001). The quality of analgesia at rest in the first 24 h was better in the spinal group (P<0.005). Excessive sedation and respiratory depression were reported in two elderly patients with spinal analgesia. There were no differences between the two groups in other outcomes (return of bowel function and dietary intake, readiness to hospital discharge, and length of hospital stay).
Conclusions When ERAS programme is used for laparoscopic colonic resection, an intrathecal mixture of bupivacaine and morphine was associated with less postoperative opioid consumption, but has no other advantages over systemic opioids.
Introduction
Optimal analgesia is an essential component of the enhanced recovery after surgery (ERAS) programme as it would facilitate earlier out-of-bed mobilization and earlier oral intake, thus leading to shorter length of hospital stay, and accelerated convalescence. While epidural analgesia has been shown to be an important component of the ERAS programme in open colon resection, the application of this analgesic technique in laparoscopic colon surgery remains controversial. The use of patient-controlled analgesia (PCA) with morphine has been shown to provide adequate pain relief in the context of either conventional or ERAS programme; however, superior analgesia and earlier convalescence were achieved with epidural.
The study in 2002 assessing two analgesic regimens after laparoscopic colonic resection revealed that an intrathecal mixture of local anaesthetics and opioids provided superior postoperative analgesia compared with intrathecal local anaesthetics alone. However, the authors did not provide information on perioperative care used and on the outcome of bowel function. In a recent study, the combination of laparoscopy, ERAS programme, and intrathecal injection of bupivacaine and diamorphine showed a very short length of hospital stay (23 h), but no information was provided on analgesia beyond 24 h.
With this in mind, this prospective randomized trial was designed to establish whether an intrathecal mixture of bupivacaine and morphine provides a difference in postoperative consumption of opioids and quality of postoperative pain control during the first three postoperative days compared with systemic morphine in a group of patients undergoing laparoscopic colonic resection and using the ERAS programme. Recovery of bowel function, duration of hospital stay, perioperative complications, and readmission rate were also evaluated.