Epidural analgesia is associated with earlier gastrointestinal transit after radical cystectomy but does not reduce the incidence of postoperative ileus: A retrospective cohort study

Abstract

Objective: To compare the effect of combined epidural thoracic analgesia and general anaesthesia (CEGA) in radical cystectomy (RC) with respect to the return of gastrointestinal passage, the incidence of paralytic postoperative ileus (POI) compared to general anaesthesia (GA) only. Patients and methods: We conducted a retrospective review using the electronic medical records of 236 patients who underwent RCs between July 2011 and September 2018 at the Medical Center – University of Freiburg. Results: A CEGA was administered to 202 patients, while 34 patients received only GA. The baseline characteristics of patients with and without CEGA showed no significant differences. CEGA will decrease the time required for return of gastrointestinal transit as measured by time to first defecation by about 13 hours. In the first 90 days after surgery, 82 (34.7%) patients had a POI. There was no significant difference between complications in the CEGA and GA groups. Conclusion: A CEGA accelerates the return of the gastrointestinal transit but does not reduce the incidence of postoperative ileus. Level of evidence: 2b