Key result
Spinal anesthesia during colorectal surgery decreased median pain scores at 24 hours (2 vs. 5, p=0.012) and hospitalization costs, but had no impact on return of bowel function.
Why the study?
Does spinal anesthesia in addition to general anesthesia improve pain control, postoperative ileus, and costs in patients undergoing elective laparoscopic colorectal resections?
Cohort (n=170)
No
Does spinal anesthesia in addition to general anesthesia improve pain control, postoperative ileus, and costs in patients undergoing elective laparoscopic colorectal resections?
Spinal anesthesia added to general anesthesia for colorectal surgery improves postoperative pain control and reduces hospitalization costs and length of stay, without affecting the return of bowel function.
Answers are grounded in this paper and cite their sources.
May support spinal anesthesia in colorectal resections; hypothesis-generating and requires randomized confirmation.
Background Spinal anaesthesia (SA) as an adjunct to general anaesthesia has been shown to improve perioperative pain management after colorectal surgery. A subsequent reduction of opioid analgesics might further shorten postoperative ileus and costs in colorectal surgery. Aims We aimed to assess the impact of spinal anaesthesia on pain control, postoperative ileus and costs after colorectal surgery. Methods Starting in June 2021, all patients undergoing colorectal surgery at our center were offered SA in addition to general anesthesia in order to improve pain control. Patients with contraindications to SA or patients refusing SA were commonly managed with opioids in addition to basic analgesics. Data of consecutive patients undergoing elective, laparoscopic colorectal resections not receiving an ostomy between October 2021 and April 2024 were entered into a prospective database. Results Our analysis includes a total of 170 patients (112 with SA and 58 patients without SA). The majority of patients was female in both groups (54% vs. 60%, p=0.399). Laparoscopic sigmoid resection was most frequently performed in both groups (66% vs. 67%, p=0.938) followed by right hemicolectomy (21% vs. 19%, p=0.850). Spinal anaesthesia was associated with a decreased median numeric rating scale for pain at 3h (0 vs 5, p= 0.009), 6h (2 vs. 3, p=0.004) and 24h (2 vs. 5, p=0.012) following surgery. There was no difference in median time-to-flatus (27h vs. 27h, p=0.355), time-to-stool (67h vs. 71h, p=0.245) and time-to-normal diet (62h vs. 67h, p=0.155) after surgery. SA was associated with a decrease in hospital length of stay (6 days vs. 7 days, p=0.038) and total hospitalization costs (16 485 CHF vs. 18047 CHF, p=0.044). Conclusion Spinal anesthesia improves postoperative pain control and is associated with a decrease in hospitalization costs and length-of-stay. There was not impact of SA on return of bowel function.
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Krombholz et al. (2025) conducted a cohort in colorectal surgery (n=170). Spinal anesthesia vs. No spinal anesthesia (opioids and basic analgesics) was evaluated on Median numeric rating scale for pain at 24h (p=0.012). Spinal anesthesia during colorectal surgery decreased median pain scores at 24 hours (2 vs. 5, p=0.012) and hospitalization costs, but had no impact on return of bowel function.
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