title: Effect of epidural analgesia on bowel function in laparoscopic colorectal surgery: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Use of thoracic epidural analgesia (TEA) with local anesthetic and adjuncts, such as opioids, are cornerstones of ERAS (Enhanced Recovery After Surgery) and are considered to play a key role in recovery after colorectal surgery. However, its effect on bowel function may lead to prolong hospital stay and is still a matter of debate. The purpose of this systemic review was to assess whether epidural analgesia could have a detrimental effect on bowel function in laparoscopic colorectal surgery with a subsequent effect on hospital stay duration, leading to failure of ERAS in colorectal surgery.
  
  
  METHODS
  A systematic review of randomized, controlled trials for the effect of epidural analgesia on laparoscopic colorectal surgery was performed. The effect on postoperative recovery was evaluated in terms of return of bowel function as the primary outcome, whereas length of stay (LOS), pain score on visual analogue scale, operative time, and incidence of postoperative complications and side-effects of analgesia were recorded as secondary outcomes.
  
  
  RESULTS
  Six trials published between 1999 and 2011 were included in the final analysis. TEA significantly improves return of bowel function assessed by time to first bowel motion [WMD -0.62 (-1.11, -0.12) with Z = 2.43; P = 0.02, 95 % confidence interval (CI)], and pain scores [WMD -1.23 (-2.4, -0.07)] with Z = 2.07; P = 0.04, 95 % CI]. TEA did not influence duration of hospital stay [WMD -0.47 (-1.55, 0.61)] with Z = 0.85 (P = 0.39, 95 % CI). No significant increase in operative time or side effects was associated with TEA.
  
  
  CONCLUSIONS
  Despite of some beneficial effect of epidural analgesia on return of bowel function and pain in laparoscopic surgery, it does not affect LOS, which is multifactorial.
authors: Colorectal Unit Surgical Department, Our Lady of Lourdes Hospital Drogheda Co., Louth, Ireland. tahirkheli73@gmail.com
authors: Suhail A
authors: SA
authors: Khan
authors: Haseeb A
authors: HA
authors: Khokhar
authors: A R H
authors: AR
authors: Nasr
authors: Eleanor
authors: E
authors: Carton
authors: Sherif
authors: S
authors: El-Masry
mesh_terms: D015360:Analgesia, Epidural; D015179:Colorectal Neoplasms / Q000601:surgery*; D003672:Defecation; D004032:Diet; D005414:Flatulence; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D061646:Operative Time; D010149:Postoperative Pain / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D064232:Visual Analog Scale
references: Br J Surg. 2007 Jun;94(6):665-73
references: 17514701
references: Surg Endosc. 2007 Feb;21(2):247-52
references: 17160649
references: Reg Anesth Pain Med. 2001 Mar-Apr;26(2):111-7
references: 11251133
references: Br J Surg. 1988 Dec;75(12):1176-8
references: 3233467
references: Cochrane Database Syst Rev. 2000;(4):CD001893
references: 11034732
references: Surg Endosc. 2009 Jan;23(1):31-7
references: 18814016
references: J Laparoendosc Surg. 1991 Aug;1(4):221-4
references: 1834273
references: Br J Surg. 2000 Nov;87(11):1480-93
references: 11091234
references: J Gastrointest Surg. 2009 Mar;13(3):569-75
references: 18629592
references: Anesthesiology. 2005 Jul;103(1):25-32
references: 15983453
references: Anaesthesist. 1990 Jan;39(1):33-40
references: 2407144
references: Surg Laparosc Endosc. 1991 Sep;1(3):183-8
references: 1669400
references: Br J Anaesth. 1997 May;78(5):606-17
references: 9175983
references: Anesthesiology. 2007 Jan;106(1):11-8; discussion 5-6
references: 17197840
references: Am J Surg. 2005 Mar;189(3):268-72
references: 15792748
references: Br J Anaesth. 1999 Jun;82(6):817-9
references: 10562770
references: Surg Endosc. 2007 Dec;21(12):2212-9
references: 17440782
references: Reg Anesth Pain Med. 2011 May-Jun;36(3):241-8
references: 21519309
references: Br J Surg. 2012 Feb;99(2):186-91
references: 21948211
references: Control Clin Trials. 1996 Feb;17(1):1-12
references: 8721797
references: Surg Laparosc Endosc. 1991 Sep;1(3):144-50
references: 1688289
references: Br J Surg. 2011 Aug;98(8):1068-78
references: 21590762
references: Acta Anaesthesiol Scand. 1987 Feb;31(2):161-4
references: 3564873
references: Ann Surg. 2007 Mar;245(3):355-63
references: 17435541
references: Br J Surg. 1990 Jun;77(6):638-42
references: 2099750
references: Arch Surg. 2008 Aug;143(8):788-93
references: 18711040
references: Br J Surg. 2001 Nov;88(11):1498-500
references: 11683748
references: Ann Surg. 2000 Jul;232(1):51-7
references: 10862195
references: Anesthesiology. 1998 Mar;88(3):688-95
references: 9523813
references: JAMA. 2003 Nov 12;290(18):2455-63
references: 14612482
references: Br J Anaesth. 2010 Mar;104(3):292-7
references: 20124282
references: Br J Anaesth. 2006 Nov;97(5):640-6
references: 16952918
references: Anesthesiology. 2002 Sep;97(3):540-9
references: 12218518
references: Anesthesiology. 1993 Apr;78(4):666-76; discussion 22A
references: 8466067
references: Surg Endosc. 2009 Feb;23(2):276-82
references: 18363059
references: Am J Obstet Gynecol. 2007 Apr;196(4):311.e1-7
references: 17403400
references: Ann Surg. 2007 Jun;245(6):867-72
references: 17522511
references: Ann Surg. 2008 Aug;248(2):189-98
references: 18650627
references: Anesthesiology. 1995 Jun;82(6):1474-506
references: 7793661
references: Clin Nutr. 2005 Jun;24(3):466-77
references: 15896435
references: Anesth Analg. 1989 Mar;68(3):353-8
references: 2919775
references: Arch Surg. 2009 Oct;144(10):961-9
references: 19841366
references: Colorectal Dis. 2006 Jun;8(5):375-88
references: 16684081
references: J Clin Anesth. 2005 Aug;17(5):382-91
references: 16102692
references: Br J Surg. 2002 Apr;89(4):446-53
references: 11952586
references: Lancet Oncol. 2003 Jun;4(6):365-72
references: 12788410
references: Br J Surg. 2010 Sep;97(9):1401-6
references: 20603849
references: Anesthesiology. 1995 Oct;83(4):757-65
references: 7574055
references: Lancet. 2002 May 25;359(9320):1812-8
references: 12044376
references: Br J Surg. 1999 Oct;86(10):1292-5
references: 10540136
references: Colorectal Dis. 2007 Sep;9(7):584-98; discussion 598-600
references: 17506795
references: Br J Surg. 2006 Jul;93(7):800-9
references: 16775831
references: Clin Nutr. 2005 Jun;24(3):455-61
references: 15896433
references: Clin Nutr. 2002 Jun;21(3):199-206
references: 12127927
references: J Gastrointest Surg. 2011 Aug;15(8):1386-93
references: 21647766
references: Colorectal Dis. 2010 Jan;12(1):5-15
references: 19220382
references: Anaesthesia. 2002 Dec;57(12):1168-73
references: 12437707