Effect of Continuous Thoracic Epidural Analgesia on Gut Motility Following Emergency Laparotomy
Condition: Analgesia, Epidural
MeSH terms: Emergencies
Study type: Observational

Summary: 
      Continuous thoracic epidural analgesia plays a very vital role in patients undergoing
      exploratory laparotomy. It not only supports a stable perioperative hemodynamics but also
      helps in early return of bowel activity.
    

Detailed description: 
      Intestinal perforation is one of the commonest surgical emergency that the investigators
      encounter in emergency. Perioperative management of most of such patients is a challenging
      task for the anesthesiologist, as patients are often hemodynamically unstable at the time of
      their presentation to emergency. Usual plan of anesthesia for these patients is general
      anesthesia with or without an epidural block. In routine practice the investigators often
      place an epidural catheter, primarily for postoperative analgesia, unless there is some
      contraindication to epidural analgesia. Most often lower thoracic epidural is preferred
      because of longer length of the laparotomy incision. Thoracic epidural analgesia with local
      anesthetic (LA) is not only effective in managing the post-operative pain; it is also helpful
      in supplementing intra-operative analgesia with reduced requirement of anesthetic, muscle
      relaxant and the analgesic (opioid) drugs. In addition, it has also been reported to be
      associated with early return of gut motility.

      It appears that absent / significantly reduced pain leads to lesser stress response, leading
      to less sympathetic activation and lesser catecholamine release. As catecholamines are
      inhibitory to gastrointestinal motility, earlier return of gastro intestinal (GI) motility
      can be achieved by reducing perioperative pain by continuous epidural analgesia. Moreover, an
      effective epidural analgesia with LA results in avoidance of opioid analgesics for optimal
      perioperative pain relief, which too may be helpful in achieving earlier return of gut
      motility.

      Thus the investigators aimed at determining the effect of continuous thoracic epidural
      analgesia on return of gut motility in patients undergoing emergency exploratory laparotomy
      following intestinal perforation and compare it with those in whom epidural analgesia was not
      used.
    

Intervention name(s): Epidural catheter placement
Intervention type(s): Procedure
Intervention description(s): After explaining about the procedure an 18 Gauge epidural catheter was inserted into thoracic 11-12 inter vertebral space under strict asepsis. Before inserting the epidural needle same space was infiltrated with adequate amount of 2% Lignocaine with Adrenaline (1: 200,000) to make the procedure pain free. Epidural space was confirmed by loss of resistance technique.
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Selected patients were randomly divided into two groups of 30 patients each,

          -  Group-Ι : Epidural group

          -  Group-ΙΙ: Non epidural group