Effect on Bowel Motility of Using Postoperative Epidural Analgesia with Fentanyl and Bupivacaine

ABSTRACT

BACKGROUND: As a means of producing pain relief after abdominal surgery, epidural opioids have been used postoperatively, but the results for return of bowel movements are ambiguous. Gastrointestinal side effects still constitute a major drawback in both acute and chronic use of opioids. This study was undertaken to compare the effects of epidural analgesia with those of intermittent injections of analgesics on postoperative bowel motility in patients who underwent abdominal surgery. METHODS: The epidural group (n=29) received continuous epidural analgesia with bupivacaine and fentanyl postoperatively for 3 days, and the control group (n=22) received intermittent injections of analgesics (Ketoprofen 100 mg/IM/day for 3 days). RESULTS: Patients in the epidural and the control groups were similar in sex, age, and operative method. The incidence of preoperative hypoalbuminemia (less than 3.5 g/dl) and hypokalemia (less than 3.5 mmol/L) was similar in both groups. The duration of preoperative hospital stay was 6.3 days in the epidural group and 5.9 days in the control group. The epidural group showed analgesic effect superior to those of the control group. After colectomy, the time from surgery until the first passage of flatus (3.8+/-1.7 days) and feces (4.9+/-2.2 days), and the time until intake of the first postoperative meal (5.9+/-1.6 days) were similar for both control group. CONCLUSIONS: There were no differences in the postoperative bowel movement between the two groups. Epidural analgesia with local anesthetics and opioids can be used to relieve postoperative pain without prolonging the postoperative ileus.