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Comparison of the effects of patient-controlled epidural and intravenous analgesia on postoperative bowel function after laparoscopic gastrectomy: a prospective randomized study

 Jin Sun Cho  ;  Hyoung-Il Kim  ;  Ki-Young Lee  ;  Taeil Son  ;  Sun Joon Bai  ;  Haegi Choi  ;  Young Chul Yoo 
 Surgical Endoscopy , Vol.31(11) : 4688-4696, 2017 
Journal Title
 Surgical Endoscopy  
Issue Date
Administration, Intravenous ; Adult ; Aged ; Amides/administration & dosage ; Amides/adverse effects ; Analgesia, Epidural/adverse effects ; Analgesia, Epidural/methods* ; Analgesia, Patient-Controlled/adverse effects ; Analgesia, Patient-Controlled/methods* ; Analgesics, Opioid/administration & dosage ; Analgesics, Opioid/adverse effects ; Anesthetics, Local/administration & dosage ; Anesthetics, Local/adverse effects ; Defecation ; Female ; Fentanyl/administration & dosage ; Fentanyl/adverse effects ; Gastrectomy/adverse effects* ; Gastrectomy/methods ; Humans ; Ileus/chemically induced* ; Ileus/epidemiology ; Laparoscopy/adverse effects* ; Laparoscopy/methods ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Pain Management ; Pain, Postoperative/drug therapy ; Prospective Studies ; Recovery of Function/drug effects
Epidural analgesia ; Heart rate variability ; Ileus ; Laparoscopic gastrectomy
BACKGROUND: Although laparoscopic surgery significantly reduces surgical trauma compared to open surgery, postoperative ileus is a frequent and significant complication after abdominal surgery. Unlike laparoscopic colorectal surgery, the effects of epidural analgesia on postoperative recovery after laparoscopic gastrectomy are not well established. We compared the effects of epidural analgesia to those of conventional intravenous (IV) analgesia on the recovery of bowel function after laparoscopic gastrectomy. METHOD: Eighty-six patients undergoing laparoscopic gastrectomy randomly received either patient-controlled epidural analgesia with ropivacaine and fentanyl (Epi PCA group) or patient-controlled IV analgesia with fentanyl (IV PCA group), beginning immediately before incision and continuing for 48 h thereafter. The primary endpoint was recovery of bowel function, evaluated by the time to first flatus. The balance of the autonomic nervous system, pain scores, duration of postoperative hospital stay, and complications were assessed. RESULTS: The time to first flatus was shorter in the epidural PCA group compared with the IV PCA group (61.3 ± 11.1 vs. 70.0 ± 12.3 h, P = 0.001). Low-frequency/high-frequency power ratios during surgery were significantly higher in the IV PCA group, compared with baseline and those in the epidural PCA group. The epidural PCA group had lower pain scores during the first 1 h postoperatively and required less analgesics during the first 6 h postoperatively. CONCLUSIONS: Compared with IV PCA, epidural PCA facilitated postoperative recovery of bowel function after laparoscopic gastrectomy without increasing the length of hospital stay or PCA-related complications. This beneficial effect of epidural analgesia might be attributed to attenuation of sympathetic hyperactivation, improved analgesia, and reduced opioid use.
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1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실)
Yonsei Authors
김형일(Kim, Hyoung Il) ORCID logo https://orcid.org/0000-0002-6134-4523
배선준(Bai, Sun Joon)
손태일(Son, Tae Il) ORCID logo https://orcid.org/0000-0002-0327-5224
유영철(Yoo, Young Chul) ORCID logo https://orcid.org/0000-0002-6334-7541
이기영(Lee, Ki Young) ORCID logo https://orcid.org/0000-0003-4893-3195
조진선(Cho, Jin Sun) ORCID logo https://orcid.org/0000-0002-5408-4188
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