Epidural pain relief best after open colorectal surgery

By Eleanor McDermid, Senior medwireNews Reporter

Epidural analgesia provides more pain relief than continuous wound filtration with local anesthetic in patients undergoing fast-track open colorectal surgery, research shows.

Continuous wound infiltration is thought to be more cost effective than epidural analgesia, and benefits from "intuitive simplicity," say Emmanuel Futier (Estaing Hospital, Clermont-Ferrand, France) and colleagues.

"We knew [continuous wound filtration] was seen as an attractive solution for pain care in abdominal surgery recovery, but it hadn't been directly compared to the tried-and-true epidural method for colorectal surgery patients," said Futier, in a press statement.

However, "unlike after abdominal surgery, our study found [epidural analgesia] was the superior choice after colorectal surgery."

The researchers had planned to enroll 46 patients to each arm of the trial, but the study was halted after an interim analysis for ethical reasons - the 24 patients in the epidural group had significantly less postoperative pain than the 26 in the wound infiltration group. Both types of pain relief were provided within an Enhanced Recovery After Surgery program.

In the epidural group, average dynamic pain scores (when moving from supine to sitting) on a 100 mm verbal numerical rating scale remained at about 10-15 mm across postoperative days 1-3. Scores in the wound infiltration group fell from about 40 to below 20 mm, but remained significantly higher than scores in the epidural group at all times, including at hospital discharge.

Patients given epidural analgesia also had less pain at rest than those given wound infiltration during the first 3 postoperative days. Furthermore, they reached the discharge criteria for the postanesthesia care unit sooner than those in the wound infiltration group, at 104 versus 144 minutes.

The researchers also report, in Anesthesiology, that epidural analgesia improved patients' functional recovery, "which is regarded as playing a pivotal role for early rehabilitation after surgery."

Relative to wound infiltration, epidural analgesia significantly shortened the time to patients resuming a normal diet and to resumption of normal bowel activity, and patients in this group reported a better quality of sleep, which the team says reflects patient well-being, on the second and third postoperative nights.

Consequently, the median length of hospital stay was significantly shorter for patients given epidural analgesia than those treated with continuous wound infiltration.

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