title: Intrathecal analgesia and restrictive perioperative fluid management within enhanced recovery pathway: hemodynamic implications.
abstract: BACKGROUND
  Intrathecal analgesia and avoidance of perioperative fluid overload are key items within enhanced recovery pathways. Potential side effects include hypotension and renal dysfunction.
  
  
  METHODS
  From January 2010 until May 2010, all patients undergoing colorectal surgery within enhanced recovery pathways were included in this retrospective cohort study and were analyzed by intrathecal analgesia (IT) vs none (noIT). Primary outcomes measures were systolic and diastolic blood pressure, mean arterial pressure, and heart rate for 48 hours after surgery. Renal function was assessed by urine output and creatinine values.
  
  
  RESULTS
  One hundred and sixty-three consecutive colorectal patients (127 IT and 36 noIT) were included in the analysis. Both patient groups showed low blood pressure values within the first 4 to 12 hours and a steady increase thereafter before return to baseline values after about 24 hours. Systolic and diastolic blood pressure and mean arterial pressure were significantly lower until 16 hours after surgery in patients having IT compared with the noIT group. Low urine output (<0.5 mL/kg/h) was reported in 11% vs 29% (IT vs noIT; p = 0.010) intraoperatively, 20% vs 11% (p = 0.387), 33% vs 22% (p = 0.304), and 31% vs 21% (p = 0.478) for postanesthesia care unit and postoperative days 1 and 2, respectively. Only 3 of 127 (2.4%) IT and 1 of 36 (2.8%) noIT patients had a transitory creatinine increase >50%; no patients required dialysis.
  
  
  CONCLUSIONS
  Postoperative hypotension affects approximately 10% of patients within an enhanced recovery pathway and is slightly more pronounced in patients with IT. Hemodynamic depression persists for <20 hours after surgery; it has no measurable negative impact and therefore cannot justify detrimental postoperative fluid overload.
authors.affiliation: Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Hübner
authors.forename: Jenna K
authors.initials: JK
authors.lastname: Lovely
authors.forename: Marianne
authors.initials: M
authors.lastname: Huebner
authors.forename: Seth W
authors.initials: SW
authors.lastname: Slettedahl
authors.forename: Adam K
authors.initials: AK
authors.lastname: Jacob
authors.forename: David W
authors.initials: DW
authors.lastname: Larson
mesh_terms: D015360:Analgesia, Epidural / Q000379:methods*; D015179:Colorectal Neoplasms / Q000601:surgery; D003107:Colorectal Surgery; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007022:Hypotension / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D016896:Treatment Outcome