Epidural anesthesia-analgesia shortens length of stay after laparoscopic segmental colectomy for benign pathology

Anthony J. Senagore, David Whalley, Conor P. Delaney, Nagy Mekhail, Hans J. Duepree, Victor W. Fazio

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Background. Aggressive postoperative care plans after open colectomy may allow earlier discharge, especially in conjunction with preoperative tharacic epidural anesthesia-analgesia using a local anesthetic and narcotic. The purpose of this study was to evaluate the role of thoracic epidural anesthesia-analgesia using bupivacaine and fentanyl citrate in reducing lengths of stay after laparoscopic colectomy (LAC). Methods. A consecutive cohort of patients who underwent LAC and who received perioperative tharacic epidural anesthesia-analgesia (TEG) was compared with a standard group of patients (STD) undergoing LA C during the 2 months preceding the implementation of the epidural management protocol. Patients with TEG received 6 to 8 mL bupivacaine (0.25%) and fentanyl citrate (100 μg) through a T8-9 ar a T9-10 epidural catheter before the incision was made and a postoperative infusion of bupivacaine (0.1%) and fentanyl citrate (5 μg/mL) at 4 to 6 mL/h far 18 hours. STD patients had supplemental intravenous morphine. The postoperative care plan was otherwise identical between the 2 groups. Patients were matched by sex, age, and type of segmental resection. Discharge criteria included tolerance of 3 general diet meals, passage of flatus ar stool, and adequate oral analgesia. Length of stay was defined as the time from admission for the surgical procedure to discharge from the hospital. Statistical analysis included a Student t test, Wilcoxon rank sum test, chi-square trend test, and Fisher exact test where appropriate. Data are presented as mean ± SEM. Results. Procedures performed were: right hemicolectomy-ileocolectomy (TEG, n = 5; STD, n = 5); or sigmoid colectomy-rectopexy (TEG, n = 17; STD, n = 17). There was no significant difference with respect to operating room (OR) time (TEG, 102 ± 12 minutes; STD, 87 ± 17 minutes), body mass inclex (TEG, 26 ± 2; STD, 26 ± 2), or American Society of Anesthesiologists class (I-III) distribution (TEG, 3/12/10; STD, 4/11/7), or mean incision length (TEG, 3.5 ± 0.4 cm; STD, 3. 7 ± 0.3 cm.) No postoperative complications or readmissions occurred in either group. The length of stay decreased in the TEG group (TEG, 2.8 ± 0.2 days; STD, 3.9 ± 0.3; P

Original languageEnglish (US)
Pages (from-to)672-676
Number of pages5
JournalSurgery
Volume129
Issue number6
DOIs
StatePublished - 2001
Externally publishedYes

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Anesthesia and Analgesia
Epidural Analgesia
Colectomy
Epidural Anesthesia
Sexually Transmitted Diseases
Length of Stay
Pathology
Bupivacaine
Fentanyl
Postoperative Care
Nonparametric Statistics
Flatulence
Narcotics
Sigmoid Colon
Operating Rooms
Chi-Square Distribution
Local Anesthetics
Analgesia
Morphine
Meals

ASJC Scopus subject areas

  • Surgery

Cite this

Senagore, A. J., Whalley, D., Delaney, C. P., Mekhail, N., Duepree, H. J., & Fazio, V. W. (2001). Epidural anesthesia-analgesia shortens length of stay after laparoscopic segmental colectomy for benign pathology. Surgery, 129(6), 672-676. https://doi.org/10.1067/msy.2001.114648

Epidural anesthesia-analgesia shortens length of stay after laparoscopic segmental colectomy for benign pathology. / Senagore, Anthony J.; Whalley, David; Delaney, Conor P.; Mekhail, Nagy; Duepree, Hans J.; Fazio, Victor W.

In: Surgery, Vol. 129, No. 6, 2001, p. 672-676.

Research output: Contribution to journalArticle

Senagore, AJ, Whalley, D, Delaney, CP, Mekhail, N, Duepree, HJ & Fazio, VW 2001, 'Epidural anesthesia-analgesia shortens length of stay after laparoscopic segmental colectomy for benign pathology', Surgery, vol. 129, no. 6, pp. 672-676. https://doi.org/10.1067/msy.2001.114648
Senagore, Anthony J. ; Whalley, David ; Delaney, Conor P. ; Mekhail, Nagy ; Duepree, Hans J. ; Fazio, Victor W. / Epidural anesthesia-analgesia shortens length of stay after laparoscopic segmental colectomy for benign pathology. In: Surgery. 2001 ; Vol. 129, No. 6. pp. 672-676.
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abstract = "Background. Aggressive postoperative care plans after open colectomy may allow earlier discharge, especially in conjunction with preoperative tharacic epidural anesthesia-analgesia using a local anesthetic and narcotic. The purpose of this study was to evaluate the role of thoracic epidural anesthesia-analgesia using bupivacaine and fentanyl citrate in reducing lengths of stay after laparoscopic colectomy (LAC). Methods. A consecutive cohort of patients who underwent LAC and who received perioperative tharacic epidural anesthesia-analgesia (TEG) was compared with a standard group of patients (STD) undergoing LA C during the 2 months preceding the implementation of the epidural management protocol. Patients with TEG received 6 to 8 mL bupivacaine (0.25{\%}) and fentanyl citrate (100 μg) through a T8-9 ar a T9-10 epidural catheter before the incision was made and a postoperative infusion of bupivacaine (0.1{\%}) and fentanyl citrate (5 μg/mL) at 4 to 6 mL/h far 18 hours. STD patients had supplemental intravenous morphine. The postoperative care plan was otherwise identical between the 2 groups. Patients were matched by sex, age, and type of segmental resection. Discharge criteria included tolerance of 3 general diet meals, passage of flatus ar stool, and adequate oral analgesia. Length of stay was defined as the time from admission for the surgical procedure to discharge from the hospital. Statistical analysis included a Student t test, Wilcoxon rank sum test, chi-square trend test, and Fisher exact test where appropriate. Data are presented as mean ± SEM. Results. Procedures performed were: right hemicolectomy-ileocolectomy (TEG, n = 5; STD, n = 5); or sigmoid colectomy-rectopexy (TEG, n = 17; STD, n = 17). There was no significant difference with respect to operating room (OR) time (TEG, 102 ± 12 minutes; STD, 87 ± 17 minutes), body mass inclex (TEG, 26 ± 2; STD, 26 ± 2), or American Society of Anesthesiologists class (I-III) distribution (TEG, 3/12/10; STD, 4/11/7), or mean incision length (TEG, 3.5 ± 0.4 cm; STD, 3. 7 ± 0.3 cm.) No postoperative complications or readmissions occurred in either group. The length of stay decreased in the TEG group (TEG, 2.8 ± 0.2 days; STD, 3.9 ± 0.3; P",
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AU - Senagore, Anthony J.

AU - Whalley, David

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AU - Mekhail, Nagy

AU - Duepree, Hans J.

AU - Fazio, Victor W.

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N2 - Background. Aggressive postoperative care plans after open colectomy may allow earlier discharge, especially in conjunction with preoperative tharacic epidural anesthesia-analgesia using a local anesthetic and narcotic. The purpose of this study was to evaluate the role of thoracic epidural anesthesia-analgesia using bupivacaine and fentanyl citrate in reducing lengths of stay after laparoscopic colectomy (LAC). Methods. A consecutive cohort of patients who underwent LAC and who received perioperative tharacic epidural anesthesia-analgesia (TEG) was compared with a standard group of patients (STD) undergoing LA C during the 2 months preceding the implementation of the epidural management protocol. Patients with TEG received 6 to 8 mL bupivacaine (0.25%) and fentanyl citrate (100 μg) through a T8-9 ar a T9-10 epidural catheter before the incision was made and a postoperative infusion of bupivacaine (0.1%) and fentanyl citrate (5 μg/mL) at 4 to 6 mL/h far 18 hours. STD patients had supplemental intravenous morphine. The postoperative care plan was otherwise identical between the 2 groups. Patients were matched by sex, age, and type of segmental resection. Discharge criteria included tolerance of 3 general diet meals, passage of flatus ar stool, and adequate oral analgesia. Length of stay was defined as the time from admission for the surgical procedure to discharge from the hospital. Statistical analysis included a Student t test, Wilcoxon rank sum test, chi-square trend test, and Fisher exact test where appropriate. Data are presented as mean ± SEM. Results. Procedures performed were: right hemicolectomy-ileocolectomy (TEG, n = 5; STD, n = 5); or sigmoid colectomy-rectopexy (TEG, n = 17; STD, n = 17). There was no significant difference with respect to operating room (OR) time (TEG, 102 ± 12 minutes; STD, 87 ± 17 minutes), body mass inclex (TEG, 26 ± 2; STD, 26 ± 2), or American Society of Anesthesiologists class (I-III) distribution (TEG, 3/12/10; STD, 4/11/7), or mean incision length (TEG, 3.5 ± 0.4 cm; STD, 3. 7 ± 0.3 cm.) No postoperative complications or readmissions occurred in either group. The length of stay decreased in the TEG group (TEG, 2.8 ± 0.2 days; STD, 3.9 ± 0.3; P

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