Does Epidural Anesthesia Reduce Postoperative Ileus Following Colorectal Surgery?

Sisli Hamidiye Etfal Training and Research Hospital

Status: Unknown

Conditions: Colorectal Disorders; Postoperative Ileus

Treatments: Procedure: epidural anesthesia

Study type: Interventional

Funder types: Other

Identifiers

NCT04429425

CT-EPI-CRS-2020

Details and patient eligibility

About

The use of epidural analgesia (EA) has been suggested as an integral part of an enhanced recovery program for colorectal surgery. However, the effects of EA on postoperative ileus remain controversial. Some authors suggest that EA has beneficial effects for postoperative outcome and hospital stay, whereas others have reported that the role of EA in the modern perioperative care of patients undergoing open colorectal surgery has been limited. Therefore, the investigators aimed to investigate the effect of EA on postoperative outcome, particularly postoperative ileus and hospital stay in patients with colorectal surgery.

Full description

In 2016, results of Cochrane review of 22 trials on the efficacy of EA in patients undergoing abdominal surgery showed that an epidural containing a local anesthetic, with or without the addition of an opioid, accelerated the return of gastrointestinal transit (high quality of evidence) and no difference in the incidence of vomiting or anastomotic leak (low quality of evidence). For open surgery, an epidural containing a local anaesthetic would reduce the length of hospital stay (very low quality of evidence).

However, in a recent analysis from American College of Surgeons revealed that the use of EA did not improve postoperative recovery after elective colectomy in their analysis and was associated with increased postoperative ileus and prolonged hospital stay after open colectomy.

In this study, the investigators aimed to compare the efficacy of EA to reduce the postoperative ileus and hospital stay, as well in the patients undergoing colorectal surgery. This prospective randomized study planned to include 100 consecutive patients with colorectal disorders.

Enrollment: 100 estimated patients

Sex: All

Ages: 18 to 75 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• undergoing colorectal surgery due to both benign and malign disorders
• no contraindication for epidural anesthesia

Exclusion criteria

• drug use (psychotropic drugs etc) that may cause paralytic ileus
• immobile patients that ERAS protocol can not be applied on
• Anticoagulated patients with the risk of epidural hematoma,

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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100 participants in 2 patient groups

EA group

Other group

Description:

patients with colorectal surgery that willl be performed epidural anesthesia

Treatment:

Procedure: epidural anesthesia

non -EA group

No Intervention group

Description:

patients with colorectal surgery that willl be performed only general anesthesia