Effectiveness of epidural analgesia in enhanced recovery protocols following colorectal surgery

Autor: Sam Coulson, Philip H. Pucher, Anshi A. Dattani, Paul Ziprin, Alison Knaggs, Ann-Marie Howell
Rok vydání: 2014
Předmět:
Zdroj: International Journal of Surgery. 12
ISSN: 1743-9191
1989-2012
DOI: 10.1016/j.ijsu.2014.07.114
Popis: s / International Journal of Surgery 12 (2014) S13eS117 S30 0645: EFFECTIVENESS OF EPIDURAL ANALGESIA IN ENHANCED RECOVERY PROTOCOLS FOLLOWING COLORECTAL SURGERY Anshi A. Dattani, Philip H. Pucher, Sam Coulson, Ann-Marie Howell, Paul Ziprin, Alison Knaggs. St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK. Introduction: Epidural anaesthesia is a key component of enhanced recovery care following colorectal surgery. Implementation in published literature is variable, with little UK-specific data. We report retrospective data from an academic tertiary centre on the success and effectiveness of epidurals over a three-year period. Methods: All patients undergoing elective colorectal surgery were identified over a five-month period from January 2011. Following implementation of several process improvement measures, a second cohort was assessed from July 2013. Epidural failure rates and incidence of epiduralassociated complications were recorded from patient records. Results: A total of 72 patients were included. The epidural failure rate did not improve between cohorts (45% vs. 55% pre and post-intervention) despite measures to improve implementation. There was a higher rate of conversion to patient-controlled analgesia following epidural failure (15.7% vs. 47.4% pre and post-intervention), with the remainder converting to oral analgesia. There was no statistically significant difference between post-operative pneumonia rate in patients with epidural failure vs. no failure in 2013 [13.3% (2/15) vs. 11.8% (2/19) (p1⁄40.801)]. Conclusions: Epidural anaesthesia has a high failure rate. Failure is not associated with increased post-operative pneumonia risk. Our study concurs with recent international data suggesting limited effectiveness of epidurals. A more selective use in high-risk patients may be considered in future. 0656: A COMPARATIVE AUDIT OF OUTCOME AFTER LAPAROSCOPIC AND OPEN COLECTOMY FOR COLITIS Marina Diament , Janice Miller, Fiona Leitch , James Mander . Western General Hospital, Edinburgh, UK; Crosshouse Hospital, Kilmarnock, UK. Introduction: To compare the outcome of laparoscopic-assisted and open colectomy in patients with inflammatory bowel disease (IBD) in a specialist colorectal unit. Methods: All patients undergoing colectomy for IBD between 2009 and 2012 were identified from a prospectively maintained electronic database. Length of stay, mortality and morbidity including ileus, infection, bowel obstruction, respiratory failure and venous thromboembolism were compared. Results: 80 patients underwent colectomy from 2009 to 2012, 48 as emergencies. Hospital stay was 5 days shorter in the laparoscopic group. There was 1 death after open operation. The overall morbidity was 69% in the open and 44% in the laparoscopic group. Wound infection and ileus were the commonest complications with both significantly lower in the laparoscopic assisted group, p1⁄40.007 and p1⁄40.048 respectively. Conclusions: Laparoscopic colorectal resection is increasingly employed across the whole spectrum of coloproctology. This retrospective audit of an unselected cohort of IBD patients undergoing colectomy laparoscopic operations had a lower morbidity, lower mortality and shorter hospital stay. Laparoscopic colectomy for elective and emergency presentations of IBD is feasible and promising however further prospective study including detailed aspects of case selection for laparoscopic resection would be valuable before advocating a policy of laparoscopic resection for all patients. 0660: SURVIVAL OF PATIENTS WITH ISOLATED PERITONEAL CARCINOMATOSIS FROM COLORECTAL CANCER: 23 YEARS EXPERIENCE USING CONVENTIONAL TREATMENT Lewis Taylor, Umar Shariff, Alex Coupland, Haney Youssef, John Glaholm. Good Hope Hospital, Sutton Coldfield, Birmingham, UK. Introduction: Peritoneal metastasis (PM-CRC) the absence of distant metastases occurs in 3-10% of colorectal cancer cases. Survival rates are poor with conventional treatments, leading to more radical strategies incorporating cytoreductive surgery (CRS) and Heated intraperitoneal chemotherapy (HIPEC). This study aimed to investigate survival of patients with isolated PM-CRC prior to introduction of CRS/HIPEC. Methods: Data on demographics, treatments and survival for patients in our hospital with PM-CRC (synchronous/metachronous) were collected retrospectively (1989-2012). Patients with other distant metastases were excluded. Results: Of 40 patients with PM-CRC; complete data was available for 36. Median age 65 years (33-80 years); M(56%):F(44%). 24/36(66.7%) underwent surgical resection plus post-operative chemotherapy, 9/36(25%) had chemotherapy only, 3/36(8.3%) had surgical resection only. Medial survival following surgery plus chemotherapy: 23 months, chemotherapy only: 6 months, surgery only: 7.5 months. Kaplan-Meier predicted overall 1,2,3 and 5 year survival: 66.7%, 37.0%, 18.5% and 3.7% respectively. Overall median survival: 19.5 months (0-79 months). Conclusions: PM-CRC survival is poor using conventional treatments. Several published series using CRS/HIPEC have reported better outcomes using this radical treatment strategy for selected patients. This data provides a crucial baseline for comparison of survival of patient with PM-CRC prior to the introduction of CRS/HIPEC in our unit. 0666: ENDOSCOPIC TATTOOING OF COLORECTAL CANCERS AND RESECTION MARGINS Rebecca Lisseter, Claire Livsey, Nelson Wong, Peter Coyne, Ben Griffiths. Royal Victoria Infirmary, Newcastle-upon-Tyne, UK. Introduction: To assess tattooing of colorectal cancer and resection margins. Methods: Surgically resected colorectal carcinomas from June 2012 to August 2013were included. Histology reports were examined for resection margins. Results: 52 patients were included (32 male, 20 female, aged 45-88 years). 37 (71%) had tumour in the left colon and 16 (29%) were tattooed. In tattooed tumours 37.5% of resection margins were more than 5cm (range 3.290mm, mean 38mm, median 27mm). In non-tattooed tumours 23.8% of resection margins were more than 5cm (range 4-300mm, mean 40mm, median 20mm, P 1⁄4 0.19). 15 (12%) had tumour in the right colon and 11 (74%) were tattooed. In tattooed tumours 72.7% of resection margins were more than 5cm (range 30-118mm, mean 64mm, median 50mm). In nontattooed tumours 75% of resection margins were more than 5cm (range 30-65mm, mean 55mm, median 57mm, P 1⁄4 0.46). Conclusions: For left sided lesions, the percentage of resections with more than 5cm clearance was higher in tattooed lesions. Although not statistically significant, this is likely due to sample size. For right sided lesions the resectionmargins were very similar. More consistent tattooing of left sided colonic lesions will aid surgical resection with good margins. 0693: EROSION AFTER LAPAROSCOPIC VENTRAL MESH RECTOPEXY Collins Ekere, Krishnan Subramanian , Michael Lamparelli , Andrew Clarke . Poole Hospital, Poole, UK; Dorset County Hospital
Databáze: OpenAIRE
Externí odkaz: