title: A systematic review of postoperative analgesia following laparoscopic colorectal surgery.
abstract: OBJECTIVE
  The use of epidural analgesia is considered fundamental in Enhanced Recovery Protocols. However its value in the perioperative management of laparoscopic colorectal surgical patients is unclear and analgesic regimens vary. The aim of this systematic review was to examine the effects of various analgesic regimes on outcomes following laparoscopic colectomy.
  
  
  METHODS
  A systematic review of studies assessing analgesic regimes following laparoscopic colorectal resection was performed. The primary outcome of interest was length of hospital stay whilst the secondary outcomes included pain, time to tolerate a normal diet, return of bowel function and postoperative complications.
  
  
  RESULTS
  Eight studies were identified, five of which compared epidural vs patient controlled analgesia/intra-venous morphine. There were no significant differences between the groups in terms of outcomes, except pain control which was superior in the epidural group. Spinal anaesthesia using intrathecal morphine in addition to local anaesthetic, and the use of nonsteroidal anti-inflammatory agents have also been shown to reduce postoperative pain.
  
  
  CONCLUSIONS
  There is a paucity of data assessing the benefits of postoperative analgesic regimes following laparoscopic colorectal surgery and none of the protocols were shown to be clearly superior. Further studies, including the assessment of spinal analgesia are required to determine the most appropriate analgesic regime following laparoscopic colorectal surgery.
authors.affiliation: Department of Surgery, Minimal Access Therapy Training Unit, Postgraduate Medical School, University of Surrey, Guildford, GU2 7WG Surrey, UK. brucelevy22@hotmail.com
authors.forename: B F
authors.initials: BF
authors.lastname: Levy
authors.forename: H S
authors.initials: HS
authors.lastname: Tilney
authors.forename: H M P
authors.initials: HM
authors.lastname: Dowson
authors.forename: T A
authors.initials: TA
authors.lastname: Rockall
mesh_terms: D015360:Analgesia, Epidural; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D003106:Colon / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D011182:Postoperative Care / Q000379:methods*; D020127:Recovery of Function; D012007:Rectum / Q000601:surgery*
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid