EP362 - Spinal anesthesia decreases pain and total hospitalization costs but not ileus after colorectal surgery: a prospective observational study

Sunday, May 11, 2025

9:27 AM – 9:32 AM PT

Location: Monitor 9, Sails Pavilion, Upper Level

Author(s)

AW

Andrea Wirsching, n/a

Oberärztin
Departement Chirurgie
Baden, Aargau, Switzerland

Disclosure information not submitted.

Author(s)

AS

Anne F. Seidl, n/a

consultant
Kantonsspital Baden
Baden, Aargau, Switzerland

Disclosure information not submitted.
EK

Elena Krombholz, none

Surgical resident
Kantonsspital Baden, Switzerland
Zürich, Zurich, Switzerland

Disclosure information not submitted.
MF

Michael C. Frey, n/a

Resident
1Department of General-, Visceral- and Vascular Surgery; Cantonal Hospital Baden, Baden, Switzerland; Departement of Surgery and Transplantation University Hospital of Zurich, Zurich, Switzerland.
Niederrohrdorf, Aargau, Switzerland

Disclosure information not submitted.
IO

Isabelle Obrecht, n/a

Resident
Kantonsspital Baden
Basel, Basel-Stadt, Switzerland

Disclosure information not submitted.
SH

Simone Hasler-Gehrer, N/A

attending physician
catonal hospital Baden
Brugg, Aargau, Switzerland

Disclosure information not submitted.
AK

Andreas Keerl, n/a

Leitender Arzt
Kantonsspital Baden
CH 5400 Baden, Aargau, Switzerland

Disclosure information not submitted.
AK

Andrea Rita Kopp Lugli, MD, MSc

Director, Chief Physician
Department of Anesthesia & Intensive Care Medicine, Cantonal Hospital Baden
Baden, Aargau, Switzerland

Disclosure information not submitted.
MH

Michael Heesen, n/a

Head of department
Spital Oberengadin
Samaden, Graubunden, Switzerland

Disclosure information not submitted.

Senior Author(s)

AN

Antonio Nocito, A.Nocito

Prof. Dr. med.
Kantonsspital Baden AG
Baden, Aargau, Switzerland

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

ePoster Presenter(s)

Eleonora Bianchi

Resident Doctor
Kantonsspital Baden
Spreitenbach, Aargau, Switzerland

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Antonio Nocito, A.Nocito: This individual has no financial relationships with ineligible companies.

Eleonora Bianchi: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Spinal anaesthesia (SA) as an adjunct to general anaesthesia has been shown to improve perioperative pain management after colorectal surgery. A subsequent reduction of systemic opioid analgesics might further shorten postoperative ileus and costs in colorectal surgery. We aimed to assess the impact of spinal anaesthesia on pain control, postoperative ileus and costs after colorectal surgery.

Methods/Interventions: Starting in June 2021, all patients undergoing colorectal surgery at our center were offered SA in addition to general anesthesia in order to improve pain control. Patients with contraindications to SA or patients refusing SA were commonly managed with opioids in addition to basic analgesics like acetaminophen or metamizole. Data of consecutive patients undergoing elective, laparoscopic colonrectal resections not receiving an ostomy between October 2021 and April 2024 were entered into a prospective database. Ostomy reversals, low anterior resections and patients with a Charlson comorbidity index (CCI) above 4 were excluded from the analysis, due to a potential impact on return of bowel function. Pain scores, parameters of bowel function (flatus, stool, diet) and costs were compared between patients with SA and without SA. Binary variables were compared using the Chi-Square- or Fisher exact test, as applicable. For continuous variables, the Mann-Whitney-U test was applied.

Results/Outcomes: Our analysis includes a total of 170 patients (112 with SA and 58 patients without SA). The majority of patients was female in both groups (54% vs. 60%, p=0.399). A BMI between 18,5 and 30 was found in 78% and 76% of cases. After excluding patients with a CCI above 4, the median CCI score was 0 in both groups. An American Society of Anesthesiologists classification of 1 or 2 was present in 71% of patients with SA vs. 64% of patients without SA (p=0.308). Colonic resection was most often indicated for diverticular disease (58% vs. 62%, p=0.626) and adenocarcinoma (31% vs. 25%, p=0.537). Laparoscopic sigmoid resection was most frequently performed in both groups (66% vs. 67%, p=0.938) followed by right hemicolectomy (21% vs. 19%, p=0.850). Spinal anaesthesia was associated with a decreased median numeric rating scale for pain at 3h (0 vs 5, p= 0.009), 6h (2 vs. 3, p=0.004) and 24h (2 vs. 5, p=0.012) following surgery. Patients with SA had a decreased cumulative morphin consumption within the first 3 hours after surgery with no difference thereafter (3 hour- morphin consumption (median): 0 vs. 10mg, p=.0.018). There was no difference in median time-to-flatus (27h vs. 27h, p=0.355), time-to-stool (67h vs. 71h, p=0.245) and time-to-normal diet (62h vs. 67h, p=0.155) after surgery. Similarly, prolonged postoperative ileus, defined by an absence of regular bowel function 4 days after surgery was found in 4% and 7% of cases (p=0.445). SA was associated with a decrease in hospital length of stay (6 days vs. 7 days, p=0.038) and total hospitalization costs (16 485 CHF vs. 18047 CHF, p=0.044).

Conclusion/Discussion: Spinal anesthesia improves postoperative pain control and is associated with a decrease in hospitalization costs and length-of-stay. There was no impact of SA on return of bowel function after elective, laparoscopic colorectal surgery.