Randomized controlled trial comparing the controlled rehabilitation with early ambulation and diet pathway versus the controlled rehabilitation with early ambulation and diet with preemptive epidural anesthesia/analgesia after laparotomy and intestinal resection

Massarat Zutshi, Conor P. Delaney, Anthony J. Senagore, Nagy Mekhail, Brenda Lewis, Jason T. Connor, Victor W. Fazio

    Research output: Contribution to journalArticle

    113 Scopus citations

    Abstract

    Background: Multimodal postoperative care regimens accelerate recovery after abdominal surgery. The benefit of thoracic epidural (TE) analgesia over patient-controlled analgesia (PCA) remains unproven when used with a fast-track postoperative care plan. Methods: Fifty-six patients undergoing major intestinal resection, and on a fast-track postoperative care plan, were randomized to preemptive TE or PCA. Patients were evaluated at standard time points for pain score, quality of life (Short Form-36), and complications. Oral analgesia was substituted for TE and PCA on the second postoperative day. Discharge criteria were identical for both groups. Results: Six patients (20.6%) had a failed epidural. There was no difference in length of stay (5.8 versus 6.2 days, TE versus PCA, P =. 55), total length of stay (including readmissions), pain scores, quality of life, complications, or hospital costs at any time point. Conclusion: TE offers no advantage over PCA for patients undergoing major intestinal resections who are on a fast-track postoperative care plan using PCA.

    Original languageEnglish (US)
    Pages (from-to)268-272
    Number of pages5
    JournalAmerican Journal of Surgery
    Volume189
    Issue number3
    DOIs
    StatePublished - Mar 2005

    Keywords

    • Bowel resection
    • Epidural
    • Fast track
    • Length of stay
    • Postoperative care

    ASJC Scopus subject areas

    • Surgery

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