Efficacy of continuous peridural analgesia with bupivacaine and fentanyl in colon surgery

Abstract

Introduction: In colon surgery, accelerated recovery is pursued and the most advantageous analgesic method is still under debate.

Objective: To compare the analgesic efficacy of continuous epidural infusion with bupivacaine and fentanyl versus parenteral analgesia in this type of operation.

Methods: A quasiexperimental, prospective and longitudinal study was carried out with thirty patients who underwent colon surgery, between August 2018 and August 2019 at Dr. Carlos J. Finlay Central Military Hospital, nonrandomly divided into an epidural analgesia group and a multimodal intravenous analgesia group.

Results: The awakening and extubation time in the epidural group was lower (1.6 -1.8 min) than the 4.9 to 5.0 min for the multimodal group. The same happened with intensive care unit and hospital stay, although with a discrete difference. 60% of the patients from the epidural group presented hydroaerial noise within the first 24 hours and 80% expelled gasses at 48 hours or earlier, with a marked difference in the multimodal group. Analgesia was good in both groups, with lower visual analog scale values in the peridural group; only 13.3% required rescue doses compared to 26.7% in the multimodal group. The most frequent complications were hypotension (23.3%) and bradycardia (10%), without differences between groups. Analgesia accelerated recovery for 87.5% of cases in the epidural group, compared to 76% in the multimodal group.

Conclusions: Continuous epidural analgesia with bupivacaine and fentanyl is more effective than multimodal intravenous analgesia in colon surgery and accelerates postoperative recovery.