Epidural analgesia enhances functional exercise capacity and health-related quality of life after colonic surgery: results of a randomized trial.
BACKGROUND
Multimodal analgesia programs have been shown to decrease hospital stay, but it not clear which functions are restored after surgery. The objective of this study is to evaluate the impact of epidural anesthesia and analgesia on functional exercise capacity and health-related quality of life.


METHODS
Sixty-four patients undergoing elective colonic resection were randomized to either patient-controlled analgesia with morphine or thoracic epidural analgesia with bupivacaine and fentanyl (epidural group). All patients in both groups received similar perioperative care and were offered the same amount of postoperative oral nutrition and assistance with mobilization. Primary outcome was functional exercise capacity as measured by the 6-min walking test, and secondary outcome was health-related quality of life, as measured by the SF-36 health survey. These were assessed before surgery and at 3 and 6 weeks after hospital discharge. Other variables measured in hospital included pain and fatigue visual analogue scale, bowel function, time out of bed, nutritional intake, complication rate, readiness for discharge, and length of hospital stay.


RESULTS
Although the 6-min walking test and the SF-36 physical health component decreased in both groups at 3 and 6 weeks after surgery, the patient-controlled analgesia group experienced a significantly greater decrease at both times (P < 0.01). Patients in the epidural group had lower postoperative pain and fatigue scores, which allowed them to mobilize to a greater extent (P < 0.05) and eat more (P < 0.05). Length of hospital stay and incidence of complications were similar in both groups, although patients in the epidural group were ready to be discharged earlier.


CONCLUSIONS
The superior quality of pain relief provided by epidural analgesia had a positive impact on out-of-bed mobilization, bowel function, and intake of food, with long-lasting effects on exercise capacity and health-related quality of life.
Carli
Franco
F
Department of Anesthesia, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada HA1. franco.carli@muhc.mcgill.ca
Mayo
Nancy
N
Klubien
Kristine
K
Schricker
Thomas
T
Trudel
Judith
J
Belliveau
Paul
P
D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D003106:Colon / Q000601:surgery*; D004068:Digestive System Physiological Phenomena; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D004311:Double-Blind Method; D017079:Exercise Tolerance / Q000502:physiology*; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement; D009747:Nutritional Physiological Phenomena; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy* / Q000523:psychology*; D019990:Perioperative Care; D011788:Quality of Life; D012129:Respiratory Function Tests; D016896:Treatment Outcome