Abstracts
2000 Digestive Disease Week

# 2237 Effects of Perioperative Analgesia Technique on Recovery After Colon Surgery.
Robert Shen, Muhammad Nuri, Jasleen Jasleen, Ali Tavakkolizadeh, Richard A. Steinbrook, Michael J. Zinner, Stanley W. Ashley, Edward E. Whang, Boston, MA

Background: Several recent studies have suggested that choice of perioperative analgesia may affect the rate of recovery of gastrointestinal function and thus duration and cost of hospitalization after colon surgery. The objective of this study was to test this hypothesis in the context of patients on a perioperative colorectal critical pathway. Methods: A retrospective analysis of 254 consecutive cases undergoing elective right, left/sigmoid colectomy, low anterior resection (LAR), or abdominoperineal resection(APR) from December 1997-March 1999 was performed. All patients were on a standardized perioperative care protocol that included early nasogastric tube removal and early feeding with a low-fat liquid diet. Data was collected on patient demographics, perioperative anesthetic and analgesic technique, blood loss, duration of anesthesia and surgery, anesthetic and surgical complications, time to recovery of gastrointestinal function, quality of postoperative pain control, postoperative length of stay, and hospital charges/costs. Results: Perioperative epidural anesthesia provided superior analgesia in patients undergoing right (1.7 +/- 0.3 vs 3.1 +/- 0.5, p<0.02), left/sigmoid (1.9 +/- 0.3 vs 4.0 +/- 0.5, p<0.0001), and APR (1.1 +/- 0.3 vs 2.8 +/- 0.2, p<0.03) compared to patients receiving systemic intravenous patient controlled narcotic analgesics (PCA). Intraoperative blood loss was also significantly lower in the epidural group of patients undergoing LAR (317cc vs 620cc, p<0.04) and APR (518cc vs 1200 cc, p<0.005)compared to the PCA group. However, there were no statistically significant differences in time to return of gastrointestinal function, length of postoperative length of stay, or hospital charges/costs between the epidural and systemic analgesia patients in any of the groups. In patients undergoing left/sigmoid colectomy, LAR, and APR, there was a higher rate of postoperative ileus requiring reinsertion of a nasogastric tube in the epidural group. Conclusions: In the largest cohort of patients studied to date, we have shown, for the first time, that in patients undergoing elective colon surgery on a standardized perioperative protocol that eliminates variation in postoperative surgical care, the choice of anesthetic technique does not have a significant impact on time to earlier return of gastrointestinal function, postoperative length of stay, or hospital charges/costs.