Laparoscopic Colonic Resection Studies - ESRA
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Colonic Resection "2009"

Laparoscopic Colonic Resection Studies

Nine studies are included that investigated analgesic, anaesthetic or operative techniques in laparoscopic colonic resection:

LAPAROSCOPIC COLONIC RESECTION-SPECIFIC EVIDENCE

Arguments for…

  • Postoperative IV ketorolac was superior to placebo for reduction of VAS pain scores during walking on Days 1 (p<0.001), 2 (p<0.05) and 3 (p<0.001), but not on Day 4
  • Postoperative IV ketorolac significantly reduced postoperative PCA morphine requirement, compared with placebo (p=0.011; n=44)
  • Postoperative IV ketorolac was superior to placebo for reducing the time to first flatus (p=0.005; n=44)
  • Postoperative IV ketorolac significantly reduced the time to return to full diet, compared with placebo (p=0.033; n=44)

Arguments against…

  • VAS pain scores on coughing were significantly greater with IV ketorolac, compared with placebo at Day 4 (p<0.001), but there was no significant difference between the groups on Days 1, 2, and 3 (n=44)
  • There was no significant difference between the IV ketorolac and placebo groups for VAS pain scores at rest on Days 1–4
  • There was no significant difference in the length of hospital stay between the postoperative IV ketorolac and placebo groups (n=44)
  • There was no significant difference in the incidence of anastomotic leaks in the IV ketorolac and placebo groups (n=44)

 

LAPAROSCOPIC COLONIC RESECTION-SPECIFIC EVIDENCE

Arguments for…

  • Continuous intra-/postoperative IV lidocaine was superior to placebo for reducing postoperative pain scores during mobilization and on coughing Click here for more information
  • Continuous intra-/postoperative IV lidocaine was superior to placebo for reducing postoperative opioid consumption Click here for more information
  • Continuous intra-/postoperative IV lidocaine significantly reduced the dose of IV sufentanil administered during surgery, compared with placebo (p< 0.001; n=40)
  • Continuous intra-/postoperative IV lidocaine was superior to placebo for reducing the time to first flatus and first bowel movement (both p=0.001; n=40)
  • Continuous intra-/postoperative IV lidocaine significantly reduced the length of hospital stay compared with placebo (p=0.001; n=40)

Arguments against…

  • Incidence of postoperative nausea or vomiting was similar in both the continuous intra-/postoperative lidocaine and placebo groups (n=40)

LAPAROSCOPIC COLONIC RESECTION-SPECIFIC EVIDENCE

Arguments for…

  • Two of two studies showed that epidural LA plus opioid was superior to IV PCA morphine for reducing postoperative pain scores Click here for more information
  • One study showed that thoracic epidural LA + opioid was associated with significantly lower VAS fatigue scores on postoperative Day 3 (p=0.025), compared with IV PCA morphine, although there was no significant difference between the groups on Days 1, 2 and 4
  • One study found that thoracic epidural LA + opioid was superior to IV PCA opioid for reducing postoperative vomiting on Days 1 and 2 (p=0.033 and p=0.005; n=50), but not on Days 3 or 4
  • One study showed that time to first flatus and first bowel movement was significantly shorter with thoracic epidural LA + opioid, compared with IV PCA morphine (p=0.0061 and p=0.0027, respectively; n=50)
  • One study reported that time taken to return to fluid diet and full diet was significantly shorter for patients in the thoracic epidural LA + opioid group, compared with the IV PCA group (p=0.0442 and p=0.0436, respectively; n=50)
  • Thoracic epidural ropivacaine + IV PCA morphine was superior to IV PCA opioid alone, for reducing the amount of supplementary IV PCA morphine administered between surgery to Day 2 (p=0.04). However, there was no significant difference between the groups from Day 2–4, or from surgery to Day 4 overall (n=20)
  • VAS pain scores during Days 1–8 were significantly lower in the group receiving GA + thoracic epidural analgesia, compared with the group receiving GA alone (p=0.004; n=75 overall)
  • GA + thoracic epidural analgesia was superior to GA alone for reducing postoperative analgesic consumption Click here for more information
  • GA + thoracic epidural analgesia was associated with a significantly shorter time to recovery of GI function (GI-3) and time to first bowel movement (p=0.025 and p=0.038, respectively; n=75), compared with GA alone, but there was no significant difference for time to first flatus or time to solid food tolerance

Arguments against…

  • One study reported that thoracic epidural LA + opioid conferred no significant benefit over IV PCA morphine for reducing postoperative analgesic requirements (n=50)
  • One study reported that the incidence of postoperative nausea was similar in patients receiving thoracic epidural LA + opioid and IV PCA opioid (n=50)
  • One study reported that the incidence of nausea requiring antiemetics, urinary retention, hypotension, and respiratory depression was similar in the groups receiving thoracic epidural LA + opioid and IV PCA morphine (n=38)
  • Two studies of two reported no significant difference in the length of hospital stay between the groups receiving thoracic epidural LA + opioid or PCA IV morphine (n=38)
  • Thoracic epidural ropivacaine + IV PCA morphine did not confer any significant benefit for reducing VAS pain scores at rest, or during coughing, from surgery to Day 4, or the time to first bowel movement, compared with IV PCA morphine alone (n=20)
  • The incidence of postoperative nausea and vomiting, frequency of naso-gastric tube reinsertion and length of hospital stay was similar between the groups receiving GA + thoracic epidural analgesia or GA alone (n=75 overall)
  • Continuous epidural LA + IV PCA opioid versus control (IV PCA opioid alone)Click here for more information
  • GA plus thoracic epidural analgesia (TEA) versus GA alone Click here for more information

 

Subarachnoid Block / Spinal Analgesia 

LAPAROSCOPIC COLONIC RESECTION-SPECIFIC EVIDENCE – STUDY INFORMATION

Arguments for…

  • Single bolus spinal hyperbaric bupivacaine with morphine was superior to hyperbaric bupivacaine alone for reducing cumulative VAS pain scores at rest or during coughing from 0?48 h (p=0.035 and p=0.01, respectively; n=35)
  • Single bolus spinal hyperbaric bupivacaine with morphine was superior to hyperbaric bupivacaine alone for reducing supplementary morphine consumption over 48 h (p=0.003; n=35)
  • Single bolus spinal hyperbaric bupivacaine with morphine was associated with a similar incidence of nausea/vomiting to hyperbaric bupivacaine alone. However, numerically more metoclopramide tablets were required by patients receiving spinal hyperbaric bupivacaine plus morphine (22 tablets), compared with hyperbaric bupivacaine alone (12 tablets) (n=35)

LAPAROSCOPIC COLONIC RESECTION-SPECIFIC EVIDENCE

Arguments for…

  • Gasless pneumoperitoneum was associated with increased cumulative VAS pain scores during mobilization and coughing (p=0.008 and p=0.006, respectively), but not at rest, up to 30 days after surgery, compared with conventional carbon dioxide pneumoperitoneum (n=17 overall)

LAPAROSCOPIC COLONIC RESECTION-SPECIFIC EVIDENCE

Arguments for…

  • Laparoscopic resection was superior to open colonic resection for reducing postoperative pain scores Click here for more information
  • Laparoscopic resection was superior to open colonic resection for reducing supplementary analgesic consumption in four studies of four Click here for more information
  • Laparoscopic resection was superior to open colonic resection for reducing time to first flatus and bowel movement in three of four studies Click here for more information
  • Laparoscopic resection was superior to open colonic resection for reducing length of hospital stay in four of five studies Click here for more information
  • A meta-analysis of seven studies reporting analgesic outcomes showed a significant benefit of laparoscopic resection over open colonic resection for reduced pain at rest and on coughing, and reduced analgesic requirement for up to 3 days (not all studies recorded pain scores)
  • A meta-analysis of twelve studies showed that laparoscopic resection reduced morbidity, wound infection, time to recovery and hospital stay compared with open resection
  • A systematic review of laparoscopic resection of colon cancer, combined with expert opinion, concluded that pain is less severe and that less analgesia is required after laparoscopic resection than open resection
  • Hand-assisted laparoscopic colectomy was superior to open colectomy for the reduction of postoperative pain scores Click here for more information
  • Hand-assisted laparoscopic colectomy was superior to open colectomy for reducing supplementary analgesic consumption Click here for more information
  • Hand-assisted laparoscopic colectomy was superior to open colectomy for reducing the time to first flatus and first bowel movement Click here for more information
  • Two studies showed that hand-assisted laparoscopic colectomy was superior to open colectomy for reducing the length of hospital stay (p=0.004, n=81; p<0.001, n=60)
  • One study showed that hand-assisted laparoscopic colectomy was superior to open colectomy for reducing the time until first oral food intake (p<0.05, n=60)

Arguments against…

  • One study reported that there was no significant difference in the incidence of postoperative nausea and vomiting between the laparoscopic colonic resection and open colonic resection techniques (n=60)
  • Hand-assisted laparoscopic proctocolectomy conferred no significant benefit over open proctocolectomy for reducing VAS pain scores at rest and during movement on Days 1, 2, 3 and 7, and at week 4 (n=55)
  • There was no significant difference in the postoperative morphine requirement between patients who received hand-assisted laparoscopic proctocolectomy versus open proctocolectomy at 24, 48 or 72 h (n=55)
  • Hand-assisted laparoscopic proctocolectomy conferred no significant benefit over open proctocolectomy for reducing the time taken for patients to return to normal fluid or food consumption (n=55)

 

LAPAROSCOPIC COLONIC RESECTION-SPECIFIC EVIDENCE

Arguments for…

  • Operative time was significantly shorter with hand-assisted laparoscopic colectomy versus standard laparoscopic colectomy for both sigmoid/left colectomy (p=0.021; n=66) and total colectomy (p=0.015; n=29

 

  • Arguments against…

    Two studies of two reported no significant difference between hand-assisted laparoscopic and conventional laparoscopic techniques for reducing postoperative pain scores Click here for more information

  • Two studies of two reported no significant difference between hand-assisted laparoscopic and conventional laparoscopic techniques for reducing postoperative analgesic requirement Click here for more information
  • One study reported that time to passage of first flatus and return of first bowel movement, was similar with the hand-assisted laparoscopic and standard laparoscopic techniques for both sigmoid/left colectomy (n=66) and total colectomy (n=29)
  • One study found that time to first tolerance of liquids or solids was similar with hand-assisted laparoscopic and standard laparoscopic techniques for both sigmoid/left colectomy (n=66) and total colectomy (n=29)
  • One study reported that the duration of hospital stay was similar with hand-assisted laparoscopic, compared conventional laparoscopic colectomy (n=54)

LAPAROSCOPIC COLONIC RESECTION-SPECIFIC EVIDENCE

  • None cited

LAPAROSCOPIC COLONIC RESECTION-SPECIFIC EVIDENCE

Arguments against…

  • Postoperative restriction of IV fluids did not confer any benefit over the standard IV fluid regimen for reducing VAS pain scores at rest or during movement during the hospital stay (n=80)
  • Postoperative restriction of IV fluids did not confer any benefit over the standard IV fluid regimen for reducing the consumption of postoperative supplementary analgesics (n=80) Click here for more information
  • Postoperative restriction of IV fluids did not confer any benefit over the standard IV fluid regimen for reducing the incidence of postoperative nausea and vomiting (n=80)
  • Time to passage of first flatus was similar for patients allocated to the restricted postoperative IV fluid and standard postoperative IV fluid regimens (n=80)
  • Postoperative restriction of IV fluids conferred no significant benefit over the standard postoperative fluid regimen for reducing the time to medical discharge or hospital discharge (n=80)

Laxatives 

  • None cited