Pain, opioid consumption, and epidural anesthesia in patients with inflammatory bowel disease undergoing laparoscopic subtotal colectomy: an observational cohort study - Report - MDSpire
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Pain, opioid consumption, and epidural anesthesia in patients with inflammatory bowel disease undergoing laparoscopic subtotal colectomy: an observational cohort study
Pain, Opioid Use, and Epidural Anesthesia in IBD Patients Undergoing Laparoscopic Subtotal Colectomy
Overview
This cohort study assessed opioid consumption, pain scores, and epidural anesthesia outcomes in 153 inflammatory bowel disease (IBD) patients undergoing minimally invasive subtotal colectomy. Opioid use was significantly lower in patients receiving epidural anesthesia, though pain scores were similar between groups. Despite enhanced recovery protocols, length of stay and reoperation rates remained notable.
Background
Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, often requires surgical intervention within five years of diagnosis. Minimally invasive subtotal colectomy is a common procedure for disease control. Optimal perioperative analgesia is challenging due to altered pain perception and contraindications for certain analgesics in IBD patients. Epidural anesthesia is used variably, but its clinical impact on opioid use and postoperative outcomes in this population remains unclear.
Data Highlights
Parameter
Non-Epidural Group
Epidural Group
P-value
Opioid consumption in PACU (mg IME)
9.2 (3.3–15.8)
3.8 (0–15)
0.04
Opioid consumption first 24h postop (mg IME)
23.3 (10–33)
6.8 (0–21.7)
<0.001
Numerical Rating Scale (NRS) pain score in PACU
3.5 (2–4.6)
2.7 (1.3–4.3)
0.1645
Length of stay (days)
4.5 (4–7)
7 (6–12)
Not reported
Reoperation rate within 30 days (%)
18%
12%
Not reported
Patients with epidural anesthesia
0%
45%
Not applicable
Adverse events related to epidural anesthesia (%)
0%
30%
Not applicable
Key Findings
Opioid consumption in the post-anesthesia care unit (PACU) and first 24 hours postoperatively was significantly lower in patients receiving epidural anesthesia (3.8 mg vs 9.2 mg in PACU; 6.8 mg vs 23.3 mg in 24h; P=0.04 and P<0.001 respectively).
Postoperative pain scores measured by numerical rating scale (NRS) were low and not significantly different between epidural and non-epidural groups (2.7 vs 3.5; P=0.1645).
Length of hospital stay was longer in the epidural group (median 7 days) compared to the non-epidural group (median 4.5 days).
Reoperation rates within 30 days were 18% in non-epidural and 12% in epidural groups.
Among patients receiving epidural anesthesia, 18% experienced insufficient analgesic effect requiring intervention, and 30% had one or more adverse events related to epidural anesthesia.
Preoperative opioid use was present in 7–10% of patients, and over half of patients in both groups had one or more comorbidities.
Clinical Implications
Epidural anesthesia in IBD patients undergoing minimally invasive subtotal colectomy can reduce opioid requirements in the immediate postoperative period without significantly altering pain scores. However, clinicians should weigh the benefits against the relatively high rate of epidural-related adverse events and longer hospital stays. Optimizing multimodal analgesia tailored to IBD patients remains essential given their altered pain perception and contraindications to certain analgesics.
Conclusion
In this cohort of IBD patients undergoing laparoscopic subtotal colectomy, epidural anesthesia was associated with reduced opioid consumption but did not significantly improve early postoperative pain scores. Despite minimally invasive surgery and ERAS protocols, substantial length of stay and reoperation rates highlight ongoing challenges in perioperative management.
References
Danish IBD Epidemiology and Treatment References 1-12
