Gastrointestinal Motility Following Thoracic Surgery: The Effect of Thoracic Epidural Analgesia

A Randomised Controlled Trial

Argyro Zoumprouli; Aikaterini Chatzimichali; Stamatios Papadimitriou; Alexandra Papaioannou; Evaghelos Xynos; Helen Askitopoulou

Disclosures

BMC Anesthesiol. 2017;17(139) 

In This Article

Results

Of the 40 patients enrolled, 34 were randomised (Figure 1), and 30 completed the study (3 women and 27 men), 31 to 82 years old, ASA physical status III.

Figure 1.

Consolidating Standards of Reporting Trials (CONSORT) diagram

The three groups did not differ significantly regarding patient demographics, type and duration of surgery, intraoperative blood loss and fluid replacement (Table 1). Intraoperatively, none of the patients had obvious vagal damage. The epidural catheter was inserted between T5-T9 levels. The upper sensory level of the block in the epidural groups had a median at T4 (T3-T5), while the lower sensory level had a median at T9 (T8-T11) (Table 1). No patient experienced postoperative motor blockade.

The preoperative OCTT and CCT tests were not different between the three groups (p = 0.44 and p = 0.28 respectively) (Table 2). The total intraoperative doses of ropivacaine between the two epidural groups did not differ statistically (p = 0.739), in contrast to morphine that was administered via two different routes (Table 3). On the whole, the OCTT demonstrated a 2.5-fold decrease of bowel motility on the first postoperative day (OCTT0 100 ± 64.73 vs OCTT1 256.16 ± 95.59). The GLM analysis of the OCTT measures revealed a significant effect between groups (F = 408.192, p < 0.001) and also between days (F = 30.126, p < 0.001). More precisely, there was a statistically significant difference in OCCT measurements between all groups (Ep-R vs Ep-RM, p = 0.43/Ep-R vs IV-M, p = 0.039/EpRM vs IV-M, p < 0.001), as well as between days (Ep-R vs Ep-RM p < 0.001/Ep-R vs IV-M, p < 0.001/Ep-RM vs IV-M, p = 0.014). No interaction was found between groups and OCTT tests (Figure 2).

Figure 2.

GLM Repeated Measures Results Data are expressed as mean ± SD. (Ep-R = Epidural Ropivacaine, Ep-RM = Epidural Ropivacaine and Morphine, IV-M = Intravenous Morphine, OCTT0 = oro-ceacal transit time preoperatively, OCTT1 = oro-ceacal transit time first postoperative day, OCTT3 = oro-ceacal transit time third postoperative day

There was no significant difference between groups in the migration of radiopaque markers (Table 2), as well as in the presence of bowel sounds and the passage of flatus on the first or third postoperative days. However, 70% of the patients in the Ep-R group and 80% in the Ep-RM group defecated by the third day compared to only 10% in the IV-M group, a statistically significant finding (p = 0.004) (Table 2). Spearman's rank correlation coefficient was used to explore the relationship between defecation and presence of radiopaques on the first postoperative day (Rho = −0.13, p = 0.48 and third postoperative day (Rho = −0.38, p = 0.04).

The total amount of ropivacaine administered by the first and third postoperative days was not different between the epidural groups, in contrast to the amount of morphine that was much higher in the IV-M group (Table 3). The correlation between total ropivacaine dose and OCTT was explored and was not significant (Table 4). Throughout the postoperative period, all patients had adequate analgesia, with no significant differences between groups for the VAS pain scores at rest or during ambulation (Table 5). The non-parametric Spearman coefficient showed no correlation between VAS rest or dynamic and the OCTT values of the first and third postoperative days.

Postoperative hemodynamic data between groups were not significantly different (Table 1). All patients were discharged on the sixth postoperative day as per local surgical protocol.

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