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Postoperative pain and gastro-intestinal recovery after colonic resection with epidural analgesia and multimodal rehabilitation

Werner, Mads LU ; Gaarn-Larsen, L; Basse, L; Jakobsen, DH; Lund, C; Billesbolle, P and Kehlet, H (2005) In Acute Pain 1(1). p.5-11
Abstract
The aim of the study was to evaluate initial postoperative pain intensity and the association with recovery of gastrointestinal function and length of stay (LOS) in a multimodal programme with epidural analgesia, early oral nutrition and mobilisation with a 48 h planned hospital stay. One hundred and ten consecutive patients scheduled for elective open colonic resection under general anaesthesia with combined thoracic epidural analgesia were prospectively studied. Postoperative epidural analgesia was maintained for 48 h with bupivacaine 2.5 mg/ml and morphine 50 μg/ml, 4 ml/h. Postoperative pain scores were assessed during cough on a categorical scale (0: no pain, 1: slight pain, 2: moderate pain, 3: severe pain) 24 and 48 h after surgery.... (More)
The aim of the study was to evaluate initial postoperative pain intensity and the association with recovery of gastrointestinal function and length of stay (LOS) in a multimodal programme with epidural analgesia, early oral nutrition and mobilisation with a 48 h planned hospital stay. One hundred and ten consecutive patients scheduled for elective open colonic resection under general anaesthesia with combined thoracic epidural analgesia were prospectively studied. Postoperative epidural analgesia was maintained for 48 h with bupivacaine 2.5 mg/ml and morphine 50 μg/ml, 4 ml/h. Postoperative pain scores were assessed during cough on a categorical scale (0: no pain, 1: slight pain, 2: moderate pain, 3: severe pain) 24 and 48 h after surgery. Sum of pain scores (24 + 48 h assessments) was compared with time to first postoperative defaecation and LOS. Data from 19 patients were excluded because of change in the surgical procedures (2), surgical morbidity (6), medical factors (4) and psychosocial or other factors (5) all independent of pain. Pain data were incomplete in two patients and therefore excluded. In the remaining 91 patients, median time to defaecation and LOS were 24 and 48 h, respectively. Gastrointestinal recovery and LOS did not differ between patients with high (3–6) versus low (0–2) dynamic pain scores (P > 0.4 and P > 0.1, respectively). It is concluded that a multimodal rehabilitation program including continuous thoracic epidural analgesia leads to early recovery of gastrointestinal function and sufficient analgesia allowing discharge within 2–3 days in most patients after colonic resection. (Less)
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author
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Acute pain, Multimodal rehabilitation, Postoperative outcome, Length of stay, Ileus, Epidural analgesia, Colonic surgery, Acute pain service
in
Acute Pain
volume
1
issue
1
pages
5 - 11
publisher
Elsevier
external identifiers
  • Scopus:20444366963
DOI
10.1016/j.acpain.2005.01.001
language
English
LU publication?
no
id
ca28eace-4617-4260-b747-eef9625350ac (old id 1134158)
date added to LUP
2008-06-18 13:21:36
date last changed
2016-10-13 04:40:25
@misc{ca28eace-4617-4260-b747-eef9625350ac,
  abstract     = {The aim of the study was to evaluate initial postoperative pain intensity and the association with recovery of gastrointestinal function and length of stay (LOS) in a multimodal programme with epidural analgesia, early oral nutrition and mobilisation with a 48 h planned hospital stay. One hundred and ten consecutive patients scheduled for elective open colonic resection under general anaesthesia with combined thoracic epidural analgesia were prospectively studied. Postoperative epidural analgesia was maintained for 48 h with bupivacaine 2.5 mg/ml and morphine 50 μg/ml, 4 ml/h. Postoperative pain scores were assessed during cough on a categorical scale (0: no pain, 1: slight pain, 2: moderate pain, 3: severe pain) 24 and 48 h after surgery. Sum of pain scores (24 + 48 h assessments) was compared with time to first postoperative defaecation and LOS. Data from 19 patients were excluded because of change in the surgical procedures (2), surgical morbidity (6), medical factors (4) and psychosocial or other factors (5) all independent of pain. Pain data were incomplete in two patients and therefore excluded. In the remaining 91 patients, median time to defaecation and LOS were 24 and 48 h, respectively. Gastrointestinal recovery and LOS did not differ between patients with high (3–6) versus low (0–2) dynamic pain scores (P > 0.4 and P > 0.1, respectively). It is concluded that a multimodal rehabilitation program including continuous thoracic epidural analgesia leads to early recovery of gastrointestinal function and sufficient analgesia allowing discharge within 2–3 days in most patients after colonic resection.},
  author       = {Werner, Mads and Gaarn-Larsen, L and Basse, L and Jakobsen, DH and Lund, C and Billesbolle, P and Kehlet, H},
  keyword      = {Acute pain,Multimodal rehabilitation,Postoperative outcome,Length of stay,Ileus,Epidural analgesia,Colonic surgery,Acute pain service},
  language     = {eng},
  number       = {1},
  pages        = {5--11},
  publisher    = {ARRAY(0x9558368)},
  series       = {Acute Pain},
  title        = {Postoperative pain and gastro-intestinal recovery after colonic resection with epidural analgesia and multimodal rehabilitation},
  url          = {http://dx.doi.org/10.1016/j.acpain.2005.01.001},
  volume       = {1},
  year         = {2005},
}