Korean J Anesthesiol.  1999 Nov;37(5):838-847. 10.4097/kjae.1999.37.5.838.

The Effects of Combined Epidural-General Anesthesia and Postoperative Epidural Analgesia on Recovery of Bowel Function and Complications in Colon Surgery

• Baik HJ

• KMID: 2239024
• DOI: http://doi.org/10.4097/kjae.1999.37.5.838

Abstract

BACKGROUND: The combination of epidural opioids and local anesthetics provides synergistic analgesia and appears to provide superior analgesia with activity. But the effects of both drugs on bowel motility are oppositional. The object of this study is to evaluate the effect of combined epidural-general anesthesia and postoperative epidural analgesia on the recovery of bowel function and on complications in colon surgery.
METHODS
84 patients were allocated to three groups. 29 patients received intraoperative epidural- general anesthesia and continuous epidural analgesia with local anesthetic-opioid for 48 hours postoperatively (Group I). Group II (n = 25) and Group III (n = 30) received intraoperative general anesthesia alone with postoperative epidural analgesia with an intramuscular injection of analgesics, respectively. We compared the pain score and side effects of these analgesic methods, recovery of bowel movements, postoperative complications and postoperative hospital stay among groups.
RESULTS
Groups I and II showed better analgesic effects at rest and upon coughing when compared with Group III (P<0.05). There were no significant differences in the incidences of nausea and vomiting, pruritus, motor blockade and the recovery time of bowel movement and postoperative hospital stay among groups. The incidences of ileus/wound complication and dysrhythmia were not different, but the incidence of pulmonary complication in group I (0%) was significantly lower than in group II (12%) and III (20%) (P<0.05).
CONCLUSIONS
Combined epidural-general anesthesia and postoperative epidural analgesia results in decreases in the pain score and in the incidence of pulmonary complication. Moreover, epidural analgesia using local anesthetic and opioid does not affect side effects, recovery time of bowel motility, incidences of ileus/wound and dysrhythmia complications.

Keyword

Analgesia, postoperative, epidural, intramuscular; Anesthetic techniques, combined epidural-general, general; Complications, cardiovascular, gastrointestinal, pulmonary; Gastrointestinal tract, bowel motility; Surgery, abdominal

MeSH Terms

Analgesia
Analgesia, Epidural*
Analgesics
Analgesics, Opioid
Anesthesia*
Anesthesia, General
Anesthetics, Local
Colon*
Cough
Humans
Incidence
Injections, Intramuscular
Length of Stay
Nausea
Postoperative Complications
Pruritus
Vomiting
Analgesics
Analgesics, Opioid
Anesthetics, Local