Is Local Surgical Site Infiltration as Efficacious as Epidural Analgesia in Laparoscopic Low Anterior Resection? UC06-UC09
Dr. Gigi Varghese,
112/2c7, New Sunset Avenue, Christian Medical College, Bagayam, Vellore-632002, Tamil Nadu, India.
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Introduction: Role of epidural analgesia in laparoscopic surgery is questionable. There is paucity of data comparing local surgical site infiltration with epidural analgesia in laparoscopic colorectal resections.
Aim: To evaluate the efficacy and feasibility of local surgical site infiltration versus epidural analgesia in laparoscopic low anterior resection done for adenocarcinoma of the rectum.
Materials and Methods: This retrospective cohort study was done on 37 patients who had undergone laparoscopic low anterior resection at a single institution from January 2014 to March 2016. Patients were divided into two cohorts; Infiltration group (n=23) and Epidural group (n=14). Baseline characteristics and postoperative outcomes like number of patients requiring opioid rescue analgesia, incidence of urinary tract infection, postoperative hospital stay and overall morbidity were compared. Statistical analysis was done using SPSS software version 16.0. Mann-Whitney U test, Fischer’s-exact test and Pearson Chi-square test were used to test the significance wherever necessary.
Results: The number of patients requiring rescue opioid analgesia within the first 48 hours following surgery were 5 (35.7%) in the epidural group versus 4 (17.4%) in the infiltration group (p=0.255). The incidence of urinary tract infection at the index admission was 2 (14.3%) in the epidural group versus 2 (8.7%) in the infiltration group (p=0.625). Overall morbidity calculated using Clavien Dindo classification was 8 (57.14%) and 14 (60.8%) respectively in epidural and infiltration group (p=0.836). The median (interquartile range) postoperative hospital stay for the epidural group was nine days (5-13 days) and for the infiltration group was eight days (5-15 days).
Conclusion: Surgical site infiltration is a simple technique comparable to epidural analgesia for immediate postoperative pain control in terms of efficacy and feasibility in laparoscopic low anterior resections.