Why the study?
Does high epidural analgesia improve gastrointestinal electrical activity compared to systemic opioids in patients after cholecystectomy?
Does high epidural analgesia improve gastrointestinal electrical activity compared to systemic opioids in patients after cholecystectomy?
High epidural analgesia may be useful in treating postoperative adynamic ileus by improving gastrointestinal electrical activity.
Epidural bupivacaine was associated with increased GI electrical activity; hypothesis-generating for ileus treatment, requires RCTs before practice change.
The electrical activity of the stomach and intestine was monitored during the postoperative period in 30 patients who underwent cholecystectomy. All patients received standard general anesthesia with artificial ventilation during operation; some received high epidural analgesia during surgery and postoperatively, and others, fentanyl analgesia during surgery and nicomorphine afterwards. Electroenterography (EEnG) showed that electrical activity decreased following surgery and returned to base line on the third or fourth day after operation. A marked increase in amplitude and frequency of EEnG oscillations was recorded in 80% of the patients who received bupivacaine injections into the epidural space. A decrease was almost always recorded after nicomorphine injections. During the postoperative period, eating caused a considerable increase in the amplitude and frequency of the electrical activity of the stomach and intestine in patients treated by epidural analgesia, whereas no observable change was recorded in patients treated by nicomorphine injections. It appears that high epidural analgesia may be useful in the treatment of postoperative adynamic ileus.
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Simon Gelman (1977) studied this question.
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