Effect of thoracic epidural analgesia on recovery of bowel function after major upper abdominal surgery.
STUDY OBJECTIVE We investigated whether thoracic epidural analgesia (TEA) shortens the first gas out time compared to intravenous patient controlled analgesia (iv PCA) and promotes earlier discharge after major upper abdominal surgery. DESIGN Prospective observational study. SETTING A tertiary care university hospital. PATIENTS Fifty six patients undergoing major upper abdominal surgery. INTERVENTIONS TEA (n=28) was performed using a paramedian approach at T6 7 or T7 8. Hydromorphone (8 mg/mL) was added to 0.15% ropivacaine (bolus/lockout time/basal: 3 mL/15 minutes/5 mL) The iv PCA regimen (n=28) included 20 mg/mL fentanyl (bolus/lockout time/basal: 0.5 mL/15 minutes/0.5 mL) The 2 analgesic methods were maintained for 3 days. MEASUREMENT The primary end point was first gas out time, and the secondary end points were hospital discharge, pain scores, and first voiding time. MAIN RESULTS No differences in first gas out time (TEA, 4.1+ 1.2 days; iv PCA, 3.4+ 1.9 days; P=.15) or hospital stay (TEA, 9.8+ 2.2 days; iv PCA, 11.4+ 5.2 days; P=.19) were observed between the 2 groups. A visual analog pain scale scores during rest and coughing were lower in the TEA than those for iv PCA even with 40% to 46% less rescue analgesic. However, TEA delayed first voiding time (3.6+ 0.9 vs 2.8+ 1.6 days; P=.02) and required more frequent bladder catheterization (46% vs 11% P=.008) than those of iv PCA. CONCLUSION TEA with a regimen of hydromorphone (8 mg/mL) added to 0.15% ropivacaine did not provide earlier gas out compared to that of iv PCA in patients who underwent major upper abdominal surgery.
Journal of clinical anesthesia