• E Marret, C Remy, F Bonnet, and Postoperative Pain Forum Group.
• Department of Anaesthetics and Intensive Care, Tenon University Hospital, Assistance Publique, Hôpitaux de Paris, University of Pierre and Marie Curie, Paris, France. emmanuel.marret@tnn.aphp.fr
• Br J Surg. 2007 Jun 1; 94 (6): 665673665-73.

BackgroundEpidural analgesia (EA) with local anaesthetic is considered to play a key role after colorectal surgery. However, its effect on postoperative recovery is still a matter of debate.MethodsA systematic review of randomized controlled trials comparing postoperative EA and parenteral opioid analgesia after colorectal surgery was performed. The effect on postoperative recovery was evaluated in terms of length of hospital stay, pain intensity, duration of postoperative ileus, incidence of postoperative complications and side-effects.ResultsSixteen trials published between 1987 and 2005 were included. EA significantly reduced pain scores and duration of ileus (weighted mean difference - 1.55 (95 per cent confidence interval (c.i.) - 2.27 to - 0.84) days). On the other hand, it was associated with a significant increase in the incidence of pruritus (odds ratio (OR) 4.8 (95 per cent c.i. 1.3 to 17.0)), urinary retention (OR 4.3 (1.2 to 15.9)) and arterial hypotension (OR 13.5 (4.0 to 57.7)). EA did not influence duration of hospital stay.ConclusionDespite improved analgesia and a decrease in ileus, EA has some adverse effects and does not shorten the duration of hospital stay after colorectal surgery.(c) 2007 British Journal of Surgery Society Ltd.

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