Laparoscopic rectal resection without epidural catheters—does it work?

• Published in: International journal of colorectal disease 2022-09, Vol.37 (9), p.2031-2040
• Main Authors: El-Ahmar, M., Koch, F., Köhler, A., Moikow, L., Ristig, M., Ritz, J.-P.
• Format: Article
• Language: English
• Subjects: Blood pressure; Catheters; Catheters - adverse effects; Complications; Epidural; Gastroenterology; Hepatology; Humans; Internal Medicine; Intestine; Invasiveness; Laparoscopic surgery; Laparoscopy; Laparoscopy - adverse effects; Length of Stay; Medicine; Medicine & Public Health; Pain; Pain, Postoperative - etiology; Postoperative; Postoperative Complications - etiology; Postoperative Complications - surgery; Proctology; Prospective Studies; Rectal Neoplasms - surgery; Rectum; Sufentanil; Surgery; Treatment Outcome
• ISSN: 1432-1262; 0179-1958; 1432-1262
• DOI: 10.1007/s00384-022-04242-3

Purpose Placement of an epidural catheter (EC) in colorectal resections is still recommended as a valid measure to achieve a low level of pain. However, EC is associated with increased invasiveness and with an increased risk of bladder emptying disorders and a decrease in blood pressure, which all relate to delayed mobilization. Preliminary data shows that EC placement may not be necessary for laparoscopic colon resections. The aim of this prospective study was to investigate how the omission of EC placement influences short-term postoperative outcomes in laparoscopic rectal resections. Methods All laparoscopic rectal resections occurring between 2013 and 2020 were prospectively examined. Resections from January 2013 to February 2018 (group A) were compared with resections from March 2018 to December 2020 (group B; after the internal change of the perioperative pain regime). In addition to EC placement, the other target parameters of our study were urinary catheter placement during the inpatient stay, postoperative pain > 3 days on a numerical rating scale (NRS), mobilization in the first 5 postoperative days, time until the first postoperative bowel movement, postoperative complications according to Clavien-Dindo, intermediate care unit stay (IMC stay) in days, and hospital length of stay in days. Results In the entire study period, 221 laparoscopic rectal resections were performed: 122 in group A and 99 resections in group B. The frequency of EC placement and urinary catheter placement, postoperative IMC stay, and hospital length of stay was significantly lower in group B ( p