Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, St. Louis, Missouri.
Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, Missouri.
Dis Colon Rectum. 2018 Dec;61(12):1403-1409. doi: 10.1097/DCR.0000000000001226.
Thoracic epidural analgesia has been shown to be an effective method of pain control. The utility of epidural analgesia as part of an enhanced recovery after surgery protocol is debatable.
This study aimed to determine if the use of thoracic epidural analgesia in an enhanced recovery after surgery protocol decreases hospital length of stay or inpatient opioid consumption after elective colorectal resection.
This is a single-institution retrospective cohort study.
The study was performed at a high-volume, tertiary care center in the Midwest. An institutional database was used to identify patients.
All patients undergoing elective transabdominal colon or rectal resection by board-certified colon and rectal surgeons from 2013 to 2017 were included.
The main outcome was length of stay. The secondary outcome was oral morphine milligram equivalents consumed during the first 48 hours.
There were 1006 patients (n = 815 epidural, 191 no epidural) included. All patients received multimodal analgesia with opioid-sparing agents. Univariate analysis demonstrated no difference in length of stay between those who received thoracic epidural analgesia and those who did not (median, 4 vs 5 days; p = 0.16), which was substantiated by multivariable linear regression. Subgroup analysis showed that the addition of epidural analgesia resulted in no difference in length of stay regardless of an open (n = 362; p = 0.66) or minimally invasive (n = 644; p = 0.46) approach. Opioid consumption data were available after 2015 (n = 497 patients). Univariate analysis demonstrated no difference in morphine milligram equivalents consumed in the first 48 hours between patients who received epidural analgesia and those who did not (median, 135 vs 110 oral morphine milligram equivalents; p = 0.35). This was also confirmed by multivariable linear regression.
The retrospective observational design was a limitation of this study.
The use of thoracic epidural analgesia within an enhanced recovery after surgery protocol was not found to be associated with a reduction in length of stay or morphine milligram equivalents consumed within the first 48 hours. We cannot recommend routine use of thoracic epidural analgesia within enhanced recovery after surgery protocols. See Video Abstract at http://links.lww.com/DCR/A765.
胸腔硬膜外镇痛已被证明是一种有效的止痛方法。硬膜外镇痛作为术后加速康复方案的一部分的效用仍存在争议。
本研究旨在确定在择期结直肠切除术后加速康复方案中使用胸腔硬膜外镇痛是否会减少住院时间或住院期间阿片类药物的使用。
这是一项单中心回顾性队列研究。
该研究在中西部的一家高容量的三级护理中心进行。使用机构数据库来确定患者。
所有 2013 年至 2017 年期间由经过董事会认证的结肠直肠外科医生进行择期经腹结肠或直肠切除术的患者均被纳入。
主要结局是住院时间。次要结局是术后 48 小时内口服吗啡毫克当量消耗量。
共有 1006 例患者（n = 815 例硬膜外组，191 例无硬膜外组）被纳入。所有患者均接受了包括阿片类药物节约剂在内的多模式镇痛。单变量分析显示，接受胸腔硬膜外镇痛和未接受胸腔硬膜外镇痛的患者在住院时间方面无差异（中位数 4 天 vs 5 天；p = 0.16），多变量线性回归也证实了这一点。亚组分析显示，无论采用开放性（n = 362；p = 0.66）还是微创手术（n = 644；p = 0.46）方法，添加硬膜外镇痛均不会导致住院时间的差异。2015 年后获得了阿片类药物消耗数据（n = 497 例患者）。单变量分析显示，接受硬膜外镇痛和未接受硬膜外镇痛的患者在术后 48 小时内消耗的吗啡毫克当量无差异（中位数 135 比 110 口服吗啡毫克当量；p = 0.35）。这也得到了多变量线性回归的证实。
回顾性观察设计是本研究的一个局限性。
在术后加速康复方案中使用胸腔硬膜外镇痛并未发现与住院时间或术后 48 小时内消耗的吗啡毫克当量减少相关。我们不能推荐在术后加速康复方案中常规使用胸腔硬膜外镇痛。在 http://links.lww.com/DCR/A765 观看视频摘要。
