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Titolo:
Epidural analgesia and risk of anastomotic leakage
Autore:
Holte, K; Kehlet, H;
Indirizzi:
Hvidovre Univ Hosp, Dept Surg Gastroenterol, DK-2650 Hvidovre, Denmark Hvidovre Univ Hosp Hvidovre Denmark DK-2650 l, DK-2650 Hvidovre, Denmark
Titolo Testata:
REGIONAL ANESTHESIA AND PAIN MEDICINE
fascicolo: 2, volume: 26, anno: 2001,
pagine: 111 - 117
SICI:
1098-7339(200103/04)26:2<111:EAAROA>2.0.ZU;2-D
Fonte:
ISI
Lingua:
ENG
Soggetto:
MAJOR ABDOMINAL-SURGERY; SPINAL NERVE BLOCK; COLONIC SURGERY; COLORECTAL ANASTOMOSIS; POSTOPERATIVE ILEUS; ANESTHESIA; BUPIVACAINE; RESECTION; MOTILITY; RECOVERY;
Keywords:
epidural analgesia; local anesthetic; anastomotic dehiscence;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
43
Recensione:
Indirizzi per estratti:
Indirizzo: Kehlet, H Hvidovre Univ Hosp, Dept Surg Gastroenterol, DK-2650 Hvidovre, Denmark Hvidovre Univ Hosp Hvidovre Denmark DK-2650 Hvidovre, Denmark
Citazione:
K. Holte e H. Kehlet, "Epidural analgesia and risk of anastomotic leakage", REG ANES PA, 26(2), 2001, pp. 111-117

Abstract

Background and Objectives: Based on case reports of early anastomotic leakage in patients receiving epidural analgesia with local anesthetic and datato document a stimulatory effect of epidural block on gastrointestinal motility, it has been suggested that continuous infusion of epidural local anesthetic may lead to an increased incidence of anastomotic leakage. Therefore, we examined the association between continuous epidural local anestheticand anastomotic leakage by reviewing the literature. Methods: Review of controlled, randomized clinical trials aiming to investigate postoperative complications in which continuous postoperative epidural local anesthetic was administered in patients scheduled for colorectal surgery with an anastomosis. Data were obtained from a Medline search (1966-May 2000), previous review articles, references cited in original papers, and personal communication with investigators. Twelve trials including a total of 562 patients met the inclusion criteria. Results: Sixteen of 266 patients (6.0%, 95% confidence interval [CI]: 3.5%to 9.6%) receiving postoperative epidural local anesthetic or epidural local anesthetic-opioid mixtures developed anastomotic leakage, compared with 10 of 296 patients (3.4%, 95% CI: 1.6% to 6.1%) receiving epidural or systemic opioid-based analgesia (P > .05 between groups, Fisher's test). The risk of overlooking a significant difference (type II error) was approximately67% (power: 33%). Studies including more than 1,037 patients in each groupare needed to demonstrate an increased risk of anastomotic leakage from 3.4% to 6.0% with 80% power and 2 alpha = 0.05. There was no significant difference (P > .05 between groups, Fisher's test) between subgroups of study design: Epidural local anesthetic versus systemic or epidural opioid, or epidural local anesthetic-opioid mixtures versus systemic or epidural opioid. Conclusions: So far, there is no statistically significant evidence from randomized trials to indicate epidural analgesia with local anesthetic to beassociated with an increased risk of anastomotic breakdown. However, relatively few patients have been included in randomized trials, indicating a need for more studies to secure valid conclusions.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 03/07/20 alle ore 15:50:54