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Thoracic Epidural Analgesia: Does It Enhance Recovery?
David R Rosen1, Rachel C Wolfe2, Aneel Damle1
1Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, St. Louis, Missouri.
Diseases of the Colon and Rectum
|October 12, 2018
Summary
Thoracic epidural analgesia did not reduce hospital stay or opioid use in enhanced recovery after surgery protocols for colorectal resection. Routine use of thoracic epidural analgesia is not recommended within these enhanced recovery protocols.
Area of Science:
- Anesthesiology
- Surgical Outcomes
- Pain Management
Background:
- Thoracic epidural analgesia is recognized for effective pain control.
- Its role within enhanced recovery after surgery (ERAS) protocols remains debated.
Purpose of the Study:
- To evaluate if thoracic epidural analgesia in ERAS protocols reduces hospital length of stay.
- To assess if thoracic epidural analgesia decreases inpatient opioid consumption post-elective colorectal resection.
Main Methods:
- Retrospective cohort study at a tertiary care center.
- Included 1006 patients undergoing elective transabdominal colorectal resection (2013-2017).
- Compared outcomes between patients with and without thoracic epidural analgesia, controlling for multimodal analgesia.
Main Results:
- No significant difference in length of stay between epidural and non-epidural groups (median 4 vs 5 days, p=0.16).
- No difference in length of stay for open or minimally invasive approaches.
- No difference in opioid consumption (oral morphine milligram equivalents) within 48 hours (median 135 vs 110, p=0.35).
Conclusions:
- Thoracic epidural analgesia within ERAS protocols did not reduce length of stay or early opioid consumption.
- Routine use of thoracic epidural analgesia in ERAS for colorectal surgery is not supported by this study.
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