title: Role of epidural and patient-controlled analgesia in site-specific laparoscopic colorectal surgery.
abstract: OBJECTIVE
  Limited data are available comparing epidural and patient-controlled analgesia in site-specific colorectal surgery. The aim of this study was to evaluate 2 modes of analgesia in patients undergoing laparoscopic right colectomy (RC) and low anterior resection (LAR).
  
  
  METHODS
  Prospectively collected data on 433 patients undergoing laparoscopic or laparoscopic-assisted colon surgery at a single institution were retrospectively reviewed from March 2004 to February 2009. Patients were divided into groups undergoing RC (n = 175) and LAR (n = 258). These groups were evaluated by use of analgesia: epidural analgesia, "patient-controlled analgesia" alone, and a combination of both. Demographic and perioperative outcomes were compared.
  
  
  RESULTS
  Epidural analgesia was associated with a faster return of bowel function, by 1 day (P < .001), in patients who underwent LAR but not in the RC group. Delayed return of bowel function was associated with increased operative time in the LAR group (P = .05), patients with diabetes who underwent RC (P = .037), and patients after RC with combined analgesia (P = .011). Mean visual analogue scale pain scores were significantly lower with epidural analgesia compared with patient-controlled analgesia in both LAR and RC groups (P < .001).
  
  
  CONCLUSIONS
  Epidural analgesia was associated with a faster return of bowel function in the laparoscopic LAR group but not the RC group. Epidural analgesia was superior to patient-controlled analgesia in controlling postoperative pain but was inadequate in 28% of patients and needed the addition of patient-controlled analgesia.
authors.affiliation: Department of Surgery, University of Illinois Metropolitan Group Hospitals, Chicago, Illinois.
authors.forename: Jan P
authors.initials: JP
authors.lastname: Kamiński
authors.affiliation: Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois.
authors.forename: Ajit
authors.initials: A
authors.lastname: Pai
authors.affiliation: Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois.
authors.forename: Luay
authors.initials: L
authors.lastname: Ailabouni
authors.affiliation: Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois.
authors.forename: John J
authors.initials: JJ
authors.lastname: Park
authors.affiliation: Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois.
authors.forename: Slawomir J
authors.initials: SJ
authors.lastname: Marecik
authors.affiliation: Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois.
authors.forename: Leela M
authors.initials: LM
authors.lastname: Prasad
authors.affiliation: Division of Colon and Rectal Surgery, John H. Stroger Hospital of Cook County, Chicago, Illinois.
authors.forename: Herand
authors.initials: H
authors.lastname: Abcarian
mesh_terms: D015360:Analgesia, Epidural / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D003107:Colorectal Surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*
keywords: Epidural analgesia; Laparoscopic colectomy; Low anterior resection; Pain scores; Patient-controlled analgesia