An investigation into the role of epidurals in patients undergoing colorectal surgery

Richards, Eleanor Rhiannon

March 2014

Thesis or dissertation

© 2014 Eleanor Rhiannon Richards. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.

Background: Thoracic epidural anaesthesia (TEA) is routinely used for the relief of Postoperative pain in patients undergoing major colorectal surgery. TEA is often associated with hypotension, which may be refractory to intravenous fluids, causing concerns over the effect of such hypotension on anastomotic perfusion. Despite the widespread use of TEA in colorectal surgical patients, their effects on intestinal perfusion are not fully understood. Recent anaesthetic advances have provided potential alternatives to TEA for these patients, such as local anaesthetic wound catheters.

Aim: To investigate the effects of epidurals on splanchnic flow and to explore potential alternatives to thoracic epidurals for the management of pain in an enhanced recovery setting.

Methods: One systematic review of the literature, two prospective observational studies and one prospective randomised, controlled clinical trial.

Results: The findings of both the systematic review of the literature and the two prospective observational studies on the effects of TEA on splanchnic blood flow were inconsistent. These studies indicate that epidural mediated hypotension may be accompanied by a reduction in splanchnic blood flow in some patients. This effect was not consistent but when present was not corrected by intravenous fluid therapy but required vasopressor therapy. The randomised controlled trial has demonstrated that wound catheters provide a viable alternative to epidurals within an enhanced recovery program.

Conclusion: A selective approach to the use of TEA in colorectal surgery should be adopted. Their effects on splanchnic flow remain unclear. Local anaesthetic wound catheters are an effective alternative.

Hull York Medical School, The University of Hull and the University of York
MacFie, John
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