The use of epidural analgesia in laparoscopic colorectal surgery has demonstrated superiority
over conventional analgesia in controlling pain. Controversy exists, however, regarding its
cost-effectiveness and its effect on postoperative outcomes.
To examine the use of epidural analgesia in laparoscopic colorectal surgery at the national level
and to compare its outcomes with those of conventional analgesia.
Design, Setting, and Participants
This is a retrospective review of laparoscopic colorectal cases performed with or without
epidural analgesia for cancer, diverticular disease, and benign polyps. Patient demographic
characteristics, disease and procedure types, and hospital settings were listed for patients in the
epidural and conventional analgesia groups. A 1 to 4 case-matched analysis was performed, matching
for patient demographic characteristics, hospital setting, indications, and procedure type. Data
were obtained from the Nationwide Inpatient Sample between January 1, 2002, and December 31,
Main Outcomes and Measures
Total hospital charge, length of stay, mortality, pneumonia, respiratory failure, urinary tract
infection, urinary retention, anastomotic leak, and postoperative ileus.
A total of 191 576 laparoscopic colorectal cases were identified during the study period.
Epidural analgesia was used in 4102 cases (2.14%). Epidurals were more likely to be used in large
teaching hospitals, cancer cases, and rectal operations. On case-matched analysis, epidural
analgesia was associated with a longer hospital stay by 0.60 day
(P = .003), higher hospital charges by $3732.71
(P = .02), and higher rate of urinary tract infection (odds
ratio = 1.81; P = .05). Epidural analgesia did not affect
the incidence of respiratory failure, pneumonia, anastomotic leak, ileus, or urinary retention.
Conclusions and Relevance
The perioperative use of epidural analgesia in laparoscopic colorectal surgery is limited in the
United States. While epidural analgesia appears to be safe, it comes with higher hospital charges,
longer hospital stay, and a higher incidence of urinary tract infections.