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

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 <. 001) and the median length of stay for the 2 groups was similarly less (TEG, 2 days; STD, 3 days). Conclusions. These data suggest that thoracic epidural anesthesia-analgesia has a significant and favorable impact on dietary tolerance and length of stay after LAC. A thoracic epidural appears to be an important component of a postoperative care protocol, which adds further advantage to LA C without the need for labor-intensive and costty patient care plans.