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Thoracic Epidural versus Morphine Patient Controlled Analgesia After Laparoscopic Colectomy
World Journal of Laparoscopic Surgery, September-December 2008;1(3):49-52
Thoracic Epidural versus Morphine Patient

Controlled Analgesia After Laparoscopic

Colectomy

2
1 RJ Dennis, P Mills
1 SpR General Surgery, Department of General Surgery, West Suffolk Hospital, Hardwick Lane, Bury St Edmunds, Suffolk IP33 2QZ
2 Consultant anaesthetist, Department of Anesthetics, West Suffolk Hospital, Hardwick Lane, Bury St Edmunds, Suffolk IP33 2QZ

Correspondence: RJ Dennis, Department of General Surgery, Luton and Dunstable Hospital, Lewsey Road, Luton LU4 0DZ
E-mail: robertdennis@nhs.net

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Abstract One previous American study by Senagore et al demons-
trated that pain control, measured as a secondary outcome,
Despite the benefits of the laparoscopic approach to colorectal surgery
patients still experience significant levels of pain post- operatively. was significantly improved at 6 and 18 hours following laparos-
This study aimed to compare the use of thoracic epidural vs. morphine copic surgery in patients receiving TEA compared to PCA.
patient controlled analgesia in the management of pain after However the epidural opiate dosage was larger than those
laparoscopic colorectal surgery. A retrospective analysis of hospital conventionally used in European practice and the TEA arm
records was performed for 16 patients undergoing laparoscopic were allowed rescue analgesia with intravenous morphine
colorectal surgery (8 thoracic epidural, 8 patient controlled analgesia).
Visual rating scale pain scores (0 – 10) were significantly lower for boluses. One further study has shown improved analgesia in
patients managed with thoracic epidural in recovery (mean [95% CI] ) the first 48 hours after surgery with TEA using lower opiate
(0 vs. 5.3 [3.6-6.9]), at 6 hours (1 [0-2.0] vs. 5.4 [4.2-6.5]), 12 hours dosages. 7
(0.4 [0-1.1] vs. 4.4 [3.3-5.4]) and 24 hours (1.3 [0-2.8] vs. 5.9 [4.9- This paper reports our experience of TEA vs PCA in the
6.9]). Thoracic epidural offers the optimal analgesia and quality of management of patients following laparoscopic colectomy.
care to the patient following laparoscopic colectomy.
Keywords: Laparoscopic anesthesia; epidural versus morphine; METHODS
laparoscopic colectomy; anethesia in colorectal surgery.
Patients
INTRODUCTION Sixteen patients who underwent laparoscopic colectomy (right
Laparoscopic abdominal surgery avoids a large incision in the hemicolectomy, sigmoid colectomy or subtotal colectomy) were
abdominal wall, thereby reducing both postoperative pain and included in this comparative study. The two groups of patients
the initiation of the postoperative inflammatory cascade were those who received morphine PCA and those managed
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response. A number of studies including the COST trial have with TEA for postoperative pain control.
shown a reduction in analgesic requirements following Mechanical bowel preparation was used in all cases,
laparoscopic colectomy compared with open colectomy. 2-4 although limited to a single phosphate enema for right
Despite this reduction in analgesic requirements the intra- hemicolectomy. Prophylactic cefuroxime 0.75-1.5 gm and
abdominal dissection and prolonged distension of the metronidazole 500 mg were administered intravenously at the
peritoneum and abdominal wall during laparoscopic colectomy, induction of anesthesia. All patients had a catheter inserted at
results in significant postoperative pain requiring provision of surgery and removed once sufficiently mobile and once the
excellent analgesia to facilitate recovery.
In open surgery the two established techniques for epidural catheter had been removed in the TEA group. All
postoperative pain management are thoracic epidural analgesia patients were permitted clear fluids immediately after surgery
(TEA) and patient controlled analgesia (PCA) with intravenous and a full diet introduced once any distention had settled and
morphine. TEA has been shown to provide superior pain relief the patient had passed flatus. Patients were discharged from
when compared to PCA for up to 72 hours following open hospital when tolerating a normal diet and pain was well
abdominal surgery. 5 controlled on oral analgesics.

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