The effect of intraoperative thoracic epidural anesthesia and postoperative analgesia on bowel function after colorectal surgery

PURPOSE: Colorectal surgery is associated with postoperative ileus, which contributes to delayed discharge. This study was designed to investigate the effect of thoracic epidural anesthesia and analgesia on gastrointestinal function after colorectal surgery under standardized controlled postoperative care. METHODS: Forty-two patients diagnosed with either colonic cancer, diverticulitis, polyps, or adenoma, and scheduled for elective colorectal surgery, were randomly assigned to either postoperative patient-controlled analgesia (PCA) with intravenous morphine (n=21) or epidural analgesia with a mixture of bupivacaine and fentanyl (n=21). Postoperative early oral feeding and assistance to mobilization were offered to all patients. Pain visual analog scale (1–100 mm), passage of flatus and bowel movements, length of hospital stay, and readiness for discharge were recorded. RESULTS: Pain visual analog scale (visual analog scale, 1–100 mm) at rest, on coughing, and daily on mobilization was significantly lower in the epidural group compared with the patient-controlled analgesia group. Median values for the visual analog scale group were 7 (95 percent confidence interval, 2–18) mm, 19 (95 percent confidence interval, 4–38) mm, and 10 (95 percent confidence interval, 5–33) mm, respectively, and, for the patient-controlled analgesia group, were 24 (95 percent confidence interval, 18–51) mm, 59 (95 percent confidence interval, 33–74) mm, and 40 (95 percent confidence interval, 29–79) mm, respectively (P