Abstract Background The effect of regional
analgesia on perioperative infectious
complications remains unknown. We therefore tested the hypothesis that a composite of serious
infections after
colorectal surgery is less common in
patients with regional
analgesia than in those given Intravenous
Patient-Controlled Analgesia (IV-
PCA) with
opiates.
Methods Patients undergoing elective
colorectal surgery lasting one hour or more under
general anesthesia at the Cleveland Clinic Main Campus between 2009 and 2015 were included in this retrospective
analysis. Exposures were defined as regional postoperative
analgesia with epidurals or
Transversus Abdominis Plane blocks (TAP); or IV-
PCA with
opiates only. The outcome was defined as a composite of in-
hospital serious
infections, including intraabdominal
abscess, pelvic
abscess, deep or organ-space
Surgical Site Infection (SSI),
clostridium difficile,
pneumonia, or
sepsis.
Logistic regression model adjusted for the imbalanced potential confounding factors among the subset of matched surgeries was used to
report the
odds ratios along with 95% confidence limits. The significance criterion was p < 0.05. Results A total of 7811
patients met inclusion and exclusion criteria of which we successfully matched 681
regional anesthesia patients to 2862 IV-
PCA only
patients based on
propensity scores derived from potential confounding factors. There were 82 (12%) in-
hospital postoperative serious
infections in the regional
analgesia group vs. 285 (10%) in IV-
PCA patients. Regional
analgesia was not significantly associated with serious
infection (
odds ratio 1.14; 95%
Confidence Interval 0.87‒1.49; p-value = 0.339) after adjusting for surgical duration and volume of intraoperative crystalloids. Conclusion Regional
analgesia should not be selected as postoperative
analgesic technique to reduce
infections.