Yanagimoto, Y., Takiguchi, S., Miyazaki, Y., Mikami, J., Makino, T., Takahashi, T., . . . Doki, Y. (2016). Comparison of pain management after laparoscopic distal gastrectomy with and without epidural analgesia. Surgery Today, 46, 229–234.

To evaluate the effectiveness of epidural analgesia after LDG

Patients received either combined thoracic epidural  and general analgesia or general anesthesia alone.

• N = 95 (84 enrolled in the analysis)
• AGE: Mean = 66.1 (SD = 13.4) in the epidural group; mean = 66.4 (SD = 10.7) in the non-epidural group
• MALES: 71% in the epidural group, 70% in the non-epidural group  
• FEMALES: 26% in the epidural group, 30% in the non-epidural group
• CURRENT TREATMENT: Other
• KEY DISEASE CHARACTERISTICS: Previously untreated gastric cancer

• SITE: Single site   
• SETTING TYPE: Inpatient    
• LOCATION: Osaka University

PHASE OF CARE: Active anti-tumor treatment

Retrospective study of 84 patients with previously untreated gastric cancer who underwent LDG; received either combined thoracic epidural and general anesthesia or general anesthesia alone. Data was recorded on the patients, surgery, postoperative outcomes, and anesthesia-related complications.

The following data was collected: sex, age, body mass index, American Society of Anesthesiologists (ASA) anesthetic risk classification, previous laparotomy, tumor stage, lymph node dissection, reconstructive procedure, length of surgery, blood loss, postoperative complications above grade 2 in Clavien-Dindo classification, number of additional doses of analgesics required during the first three days after surgery, first day of oral intake, first day of flatus, first day of ambulation, length of hospital stay, and incidence of anesthesia-related complications such as nausea, vomiting, hypotension, bradycardia, and urinary retention.

The two groups were not significantly different with regard to the first day of ambulation, first day of oral intak,e or length of hospital stay. The epidural group experienced a significantly earlier first day of flatus and required significantly fewer additional postoperative analgesic doses compared to the non-epidural group. One patient in the epidural group experienced a urinary tract infection, which was cured with antibiotics; nevertheless, the groups did not have significantly different rates of urinary tract infection.
There was no significant differences between the epidural group and the non-epidural group in the degree of nausea, vomiting, hypotension, or bradycardia. However, significantly more (20.6%) cases of postoperative urinary retention were observed in the epidural group than the non-epidural group. Adverse events related to epidural anesthesia, such as nausea, hypotension, and bradycardia, resolved after a brief interruption or dose reduction of the epidural anesthesia.

The optimal postoperative analgesic regimens for laparoscopic gastrectomy have not yet been determined. Our findings suggest that epidural anesthesia could lead to a decreased use of additional analgesics after LDG. However, as found in previous reports, epidural anesthesia was associated with a higher risk of urinary retention.

• Small sample (< 100)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Findings not generalizable
• Subject withdrawals ≥ 10%

None included