Epidural local anaesthetics versus opioid-based regimens used for reduction of postoperative pain on nausea and vomiting (PONV) and gastrointestinal paralysis after abdominal surgery

Following abdominal surgery, pain, gastrointestinal paralysis and nausea and vomiting can cause major problems. Anaesthetic and analgesic techniques that reduce the pain, nausea and vomiting and lack of gastrointestinal function (ileus) may reduce further postoperative complications and the length of hospital stay. Opioids themselves can cause nausea and vomiting so that using opioid-sparing anaesthetic and pain-relieving (analgesic) techniques may reduce PONV and improve bowel movement (motility).
Administration of epidural local anaesthetics to patients after undergoing abdominal surgery involving a laparotomy reduced gastrointestinal paralysis compared with using systemic or epidural opioids. Pain relief was comparable. These conclusions are based on 22 randomised controlled trials involving a total of 1023 patients undergoing abdominal surgery. Publication dates were from 1984 to 2000. Results consistently showed a reduction in time to return of gastrointestinal function in patients receiving epidural local anaesthetic compared with opioids delivered systemically (by 19 to 56 hours, mean 37 hours) or epidurally (by 10 to 39 hours, mean 24 hours). No clear differences in PONV were apparent. The epidural local anaesthetic used was bupivacaine (0.1 to 0.5%), continuous or with intermittent injections, in all trials but one where ropivacaine was used. Addition of opioid to epidural local anaesthetic may provide better postoperative pain relief compared with epidural local anaesthetics alone. Only two studies compared epidural local anaesthetic with a combination of epidural local anaesthetic and opioid on gastrointestinal function, with no clear findings. Most studies involved a small number of patients and some studies appeared to have poor methodology. The surgical procedures included colon or rectal surgery, hysterectomy, caesarean section, removal of the gall bladder (cholecystectomy), abdominal aortic surgery and major abdominal gynaecological surgery.