Perioperative Analgesic Strategies in Elective Colorectal Surgery - The LapCoGesic Study
Enhanced recovery programmes are established as an essential part of laparoscopic colorectal surgery. Optimal pain management is central to the success of an enhanced recovery programme and is acknowledged to be an important patient reported outcome measure. A variety of analgesia strategies are employed in elective laparoscopic colorectal surgery ranging from patient-controlled analgesia to local anaesthetic wound infiltration catheters. However, there is little evidence regarding the optimal analgesia strategy in this cohort of patients.
The LapCoGesic study aimed to explore differences in analgesia strategies employed for patients undergoing elective laparoscopic colorectal surgery and to assess whether this variation in practice has an impact on patient-reported and clinical outcomes.
This study is a prospective, observational study of consecutive patients undergoing elective laparoscopic colorectal surgery over a two-month period.
This multi centre study was carried out in 13 centres within the North of England. These include:
- Royal Victoria Infirmary
- Freeman Hospital
- Queen Elizabeth Hospital
- North Tyneside General Hospital
- South Tyneside General Hospital
- Sunderland Royal Hospital
- Wansbeck General Hospital
- University Hospital of North Durham
- North Tees University Hospital
- Darlington Memorial Hospital
- Cumberland Infirmary
- James Cook University Hospital
- Friarage Hospital
The project was being coordinated centrally with County Durham and Darlington Foundation Trust acting as the lead trust. Each Trust had a trainee primary investigator, supported by a foundation level investigator. The process was overseen by a separate consultant supervisor within each centre.
A total of 103 patients undergoing elective laparoscopic colorectal surgery were included in the study. Thoracic epidural was used in 4 (3.9%) patients, spinal diamorphine in 56 (54.4%) patients and patient-controlled analgesia in 77 (74.8%) patients. The use of thoracic epidural and spinal diamorphine were associated with lower pain scores on day 1 postoperatively (P < 0.05). The use of patient-controlled analgesia was associated with significantly higher postoperative pain scores and pain severity.
Postoperative pain is managed in a variable manner in patients undergoing elective colorectal surgery, which has an impact on patient reported outcomes of pain scores and pain severity.