15 de março de 2013

Artigo recomendado: Epidural versus Continuous Preperitoneal Analgesia during Fast-track Open Colorectal Surgery

Philippe Jouve, Jean-Etienne Bazin, Antoine Petit, Vincent Minville, Adeline Gerard, Emmanuel Buc, Aurelien Dupre, Fabrice Kwiatkowski, Jean-Michel Constantin, Emmanuel Futie

Anesthesiology 2013; 118:622-30, Jouve et al.


Background: Effective postoperative analgesia is essential for early rehabilitation after surgery. Continuous wound infiltration (CWI) of local anesthetics has been proposed as an alternative to epidural analgesia (EA) during colorectal surgery. This prospective, double-blind trial compared CWI and EA in patients undergoing elective open colorectal surgery.

Methods: Fifty consecutive patients were randomized to receive EA or CWI for 48 h. In both groups, patients were managed according to Enhanced Recovery After Surgery recommendations. The primary outcome was the dynamic pain score measured during mobilization 24 h after surgery (H24) using a 100-mm verbal numerical scale. Secondary outcomes were time to functional recovery, analgesic technique-related side effects, and length of hospital stay.

Results: Median postoperative dynamic pain score was lower in the EA than in the CWI group (10 [interquartile range: 1.6–20] vs. 37 [interquartile range: 30–49], P < 0.001) and remained lower until hospital discharge. The median times to return of gut function and tolerance of a normal, complete diet were shorter in the EA than in the CWI group (P < 0.01 each). Sleep quality was also better in the EA group, but there was no difference in urinary retention rate (P = 0.57). The median length of stay was lower in the EA than in the CWI group (4 [interquartile range: 3.4–5.3] days vs. 5.5 [interquartile range: 4.5–7] days; P = 0.006).

Conclusion: Within an Enhanced Recovery After Surgery program, EA provided quicker functional recovery than CWI and reduced length of hospital stay after open colorectal surgery.

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