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Pain control for laparoscopic colectomy: an analysis of the incidence and utility of epidural analgesia compared to conventional analgesia

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Abstract

Purpose

The aim of this study was to compare short-term outcomes between epidural analgesia and conventional intravenous analgesia for patients undergoing laparoscopic colectomy. This paper uses a large national database to add a current perspective on trends in analgesia and the outcomes associated with two analgesia options. Our evidence augments the opinions of recent randomized controlled trials.

Methods

The University HealthSystem Consortium, an alliance of more than 300 academic and affiliate institutions, was reviewed for the time period of October 2008 through September 2014. International Classification of Disease 9th Clinical Modification codes for laparoscopic colectomy and epidural catheter placement were used.

Results

A total of 29,429 patients met our criteria and underwent laparoscopic colectomy during the study period. One hundred and ten (0.374 %) patients had an epidural catheter placed for analgesia. Baseline patient demographics were similar for the epidural and conventional analgesia groups. Total charges were significantly higher in the epidural group ($52,998 vs. $39,277; p < 0.001). Median length of stay was longer in the epidural group (6 vs. 5 days; p < 0.001). There was no statistical difference between the epidural and conventional analgesia groups in death (0 vs. 0.03 %; p = 0.999), urinary tract infection (0 vs. 0.1 %; p = 0.999), ileus (11.8 vs. 13.6 %; p = 0.582), or readmission rate (9.1 vs. 9.3 %; p = 0.942).

Conclusion

Compared to conventional analgesic techniques, epidural analgesia does not reduce the rate of postoperative ileus, and it is associated with increased cost and increased length of stay. Based on our data, routine use of epidural analgesia for laparoscopic colectomy cannot be justified.

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Acknowledgments

This work was supported by the University of Nebraska Medical Center’s Center for Advanced Surgical Technology and the Foundation for Surgical Fellowships.

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Authors and Affiliations

  1. University of Nebraska Medical Center, 986245 Nebraska Medical Center, Omaha, NE, 68198-6245, USA

    M. daSilva, D. Lomelin, J. Tsui, M. Klinginsmith & S. Langenfeld

  2. Hardin Memorial Hospital, 913 N. Dixie Ave., Elizabethtown, KY, 42701, USA

    C. Tadaki

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  1. M. daSilva
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  2. D. Lomelin
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Correspondence to M. daSilva.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

UNMC applies both the Common Rule and HHS regulations at 45 CFR 46, Subparts B, C, D and E to all of its human subject research. All research data was obtained under and approved UNMC IRB protocol.

Informed consent

Informed consent was waived for this study because it used de-identified data from a large retrospective database, in which no individually identifiable information is available.

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daSilva, M., Lomelin, D., Tsui, J. et al. Pain control for laparoscopic colectomy: an analysis of the incidence and utility of epidural analgesia compared to conventional analgesia. Tech Coloproctol 19, 515–520 (2015). https://doi.org/10.1007/s10151-015-1336-z

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  • DOI: https://doi.org/10.1007/s10151-015-1336-z

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