title: The impact of epidural analgesia compared to systemic opioid-based analgesia with regard to length of hospital stay and recovery of bowel function: retrospective evaluation of 1555 patients undergoing thoracotomy.
abstract: BACKGROUND
  To assess the protocols of epidural analgesia versus systemic opioid-based analgesia retrospectively in 1555 thoracotomies in our thoracic centre during 2011-2013.
  
  
  METHODS
  Pain therapy is aggressive and standardized in our thoracic centre thoughout the complete postoperative stay. Patients receive either standardized epidural analgesia with ropivacaine + sufentanil 4-8 mls/h (500 mls bag) and are bridged when the epidural bag is finished to a standardized controlled-release oxycodone protocol with non opioid every 6 hours (EDA Group), or patients receive immediately postoperative standardized oral analgesic protocol with controlled-released oxycodone and non opioid every 6 h (Opioid Group). All patients are visited daily by a pain specialist throughout the whole stay.
  
  
  RESULTS
  Data of 1555 thoracotomies from 2011-2013 were analysed, 838 patients in the EDA Group and 717 patients in the Opioid Group. There was no difference with regard to sex or age between groups. 7.5% of patients in the EDA Group and 13% in the Oxy Group had a preexisting pain therapy (p = 0.001). In the EDA Group epidural analgesia was performed for 4.6 ± 1.5 days. Length of hospital stay was the same in both groups (EDA: 9.9.6 ± 4.9 vs Opioid: 9.6 ± 5.8 days). 84.7% of patients in the EDA Group and 79.1% of patients of the Oxy Group were dismissed with oral opioid (p < 0.004). When patients were dismissed with opioid medication patients in the EDA Group were dismissed with higher oxycodone opioid doses than patients in the Opioid Group (29.5 ± 15.2 mg vs 26.9 ± 15.2 mg, p = 0.01). There was no difference with regard to dejection time between the two groups (EDA: 3.8 ± 2.2 days vs Opioid: 3.7 ± 1.6 days, n.s.).
  
  
  CONCLUSIONS
  We first present data monitoring postoperative analgesic protocols after thoracotomies throughout the whole stay in hospital until dismission. Our retrospective data indicate that patients with epidural analgesia stay as long in hospital as patients with systemic opioid based therapy. Patients with initial epidural analgesia are dismissed with higher oxycodone opioid doses than patients with initial opioid based postoperative analgesia. We found no difference in recovery of bowel function.
  
  
  CONCLUSIONS
  The study design is retrospectively and results might be biased.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Ruhrlandklinik, West German Lung Center - University Hospital Essen, University Duisburg-Essen, Tüschener Weg 40, 45239, Essen, Germany. Sandra.kampe@ruhrlandklinik.uk-essen.de.
authors.forename: Sandra
authors.initials: S
authors.lastname: Kampe
authors.affiliation: Department of Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany. gerhard.weinreich@ruhrlandklinik.uk-essen.de.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Weinreich
authors.affiliation: Department of Anesthesiology and Pain Medicine, Ruhrlandklinik, West German Lung Center - University Hospital Essen, University Duisburg-Essen, Tüschener Weg 40, 45239, Essen, Germany. christoph.darr@ruhrlandklinik.uk-essen.de.
authors.forename: Christopher
authors.initials: C
authors.lastname: Darr
authors.affiliation: Department of Anesthesiology and Pain Medicine, Ruhrlandklinik, West German Lung Center - University Hospital Essen, University Duisburg-Essen, Tüschener Weg 40, 45239, Essen, Germany. kolja.eicker@ruhrlandklinik.uk-essen.de.
authors.forename: Kolja
authors.initials: K
authors.lastname: Eicker
authors.affiliation: Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Lung Center - University Hospital Essen, University Duisburg-Essen, Essen, Germany. georgios.stamatis@ruhrlandklinik.uk-essen.de.
authors.forename: Georgios
authors.initials: G
authors.lastname: Stamatis
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital Magdeburg, Otto von Guericke University Magdeburg, Magdeburg, Germany. thomas.hachenberg@med.uvgu.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hachenberg
mesh_terms: D000577:Amides / Q000008:administration & dosage; D015360:Analgesia, Epidural; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010098:Oxycodone / Q000008:administration & dosage; D011184:Postoperative Period; D020127:Recovery of Function; D012189:Retrospective Studies; D000077212:Ropivacaine; D017409:Sufentanil / Q000008:administration & dosage; D013908:Thoracotomy
chemical_list: D000577:Amides; D000077212:Ropivacaine; D017409:Sufentanil; D010098:Oxycodone