Effect of thoracic epidural analgesia on recovery of bowel function after major upper abdominal surgery

Study Objective: We investigated whether thoracic epidural analgesia (TEA) shortens the first gas-out time compared to intravenous patient-controlled analgesia (iv-PCA) and promotes earlier discharge after major upper abdominal surgery. Design: Prospective observational study. Setting: A tertiary care university hospital. Patients: Fifty-six patients undergoing major upper abdominal surgery. Interventions: TEA (n = 28) was performed using a paramedian approach at T6-7 or T7-8. Hydromorphone (8 mu g/mL) was added to 0.15% ropivacaine (bolus/lockout time/basal: 3 mL/15 minutes/5 mL). The iv-PCA regimen (n = 28) included 20 mu g/mL fentanyl (bolus/lockout time/basal: 0.5 mL/15 minutes/0.5 mL). The 2 analgesic methods were maintained for 3 days. Measurement: The primary end point was first gas-out time, and the secondary end points were hospital discharge, pain scores, and first voiding time. Main Results: No differences in first gas-out time (TEA, 4.1 +/- 1.2 days; iv-PCA, 3.4 +/- 1.9 days; P =.15) or hospital stay (TEA, 9.8 +/- 2.2 days; iv-PCA, 11.4 +/- 5.2 days; P =.19) were observed between the 2 groups. A visual analog pain scale scores during rest and coughing were lower in the TEA than those for iv-PCA even with 40% to 46% less rescue analgesic. However, TEA delayed first voiding time (3.6 +/- 0.9 vs 2.8 +/- 1.6 days; P =.02) and required more frequent bladder catheterization (46% vs 11%; P =.008) than those of iv-PCA. Conclusion: TEA with a regimen of hydromorphone (8 mu g/mL) added to 0.15% ropivacaine did not provide earlier gas-out compared to that of iv-PCA in patients who underwent major upper abdominal surgery. (C) 2016 Elsevier Inc. All rights reserved.