• Gynecologic oncology · Nov 2013

    Randomized Controlled Trial Multicenter Study

    Epidural analgesia is associated with an increased incidence of postoperative complications in patients requiring an abdominal hysterectomy for early stage endometrial cancer.

    • David Belavy, Monika Janda, Jannah Baker, and Andreas Obermair.
    • The University of Queensland, Burns, Trauma and Critical Care Research Centre, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD 4029, Australia. Electronic address: david@belavy.com.
    • Gynecol. Oncol. 2013 Nov 1; 131 (2): 423-9.

    ObjectiveAnalgesia and early quality of recovery may be improved by epidural analgesia. We aimed to assess the effect of receiving epidural analgesia on surgical adverse events and quality of life after laparotomy for endometrial cancer.MethodsPatients were enrolled in an international, multicentre, prospective randomised trial of outcomes for laparoscopic versus open surgical treatment for the management of apparent stage I endometrial cancer (LACE trial). The current analysis focussed on patients who received an open abdominal hysterectomy via vertical midline incision only (n=257), examining outcomes in patients who did (n=108) and did not (n=149) receive epidural analgesia.ResultsBaseline characteristics were comparable between patients with or without epidural analgesia. More patients without epidural (34%) ceased opioid analgesia 3-5 days after surgery compared to patients who had an epidural (7%; p<0.01). Postoperative complications (any grade) occurred in 86% of patients with and in 66% of patients without an epidural (p<0.01) but there was no difference in serious adverse events (p=0.19). Epidural analgesia was associated with increased length of stay (up to 48 days compared to up to 34 days in the non-epidural group). There was no difference in postoperative quality of life up to six months after surgery.ConclusionsEpidural analgesia was associated with an increase in any, but not serious, postoperative complications and length of stay after abdominal hysterectomy. Randomised controlled trials are needed to examine the effect of epidural analgesia on surgical adverse events, especially as the present data do not support a quality of life benefit with epidural analgesia.© 2013.

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