Postoperative pain and gastro-intestinal recovery after colonic resection with epidural analgesia and multimodal rehabilitation☆

Summary 

The aim of the study was to evaluate initial postoperative pain intensity and the association with recovery of gastrointestinal function and length of stay (LOS) in a multimodal programme with epidural analgesia, early oral nutrition and mobilisation with a 48h planned hospital stay. One hundred and ten consecutive patients scheduled for elective open colonic resection under general anaesthesia with combined thoracic epidural analgesia were prospectively studied. Postoperative epidural analgesia was maintained for 48h with bupivacaine 2.5mg/ml and morphine 50μg/ml, 4ml/h. Postoperative pain scores were assessed during cough on a categorical scale (0: no pain, 1: slight pain, 2: moderate pain, 3: severe pain) 24 and 48h after surgery. Sum of pain scores (24+48h assessments) was compared with time to first postoperative defaecation and LOS. Data from 19 patients were excluded because of change in the surgical procedures (2), surgical morbidity (6), medical factors (4) and psychosocial or other factors (5) all independent of pain. Pain data were incomplete in two patients and therefore excluded. In the remaining 91 patients, median time to defaecation and LOS were 24 and 48h, respectively. Gastrointestinal recovery and LOS did not differ between patients with high (3–6) versus low (0–2) dynamic pain scores (P>0.4 and P>0.1, respectively). It is concluded that a multimodal rehabilitation program including continuous thoracic epidural analgesia leads to early recovery of gastrointestinal function and sufficient analgesia allowing discharge within 2–3 days in most patients after colonic resection.

Keywords: Acute pain, Acute pain service, Colonic surgery, Epidural analgesia, Ileus, Length of stay, Multimodal rehabilitation, Postoperative outcome