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

Belavy, David, Janda, Monika, Baker, Jannah, & Obermair, Andreas (2013) Epidural analgesia is associated with an increased incidence of postoperative complications in patients requiring an abdominal hysterectomy for early stage endometrial cancer. Gynecologic Oncology, 131(2), pp. 423-429.

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Abstract

Objective

Analgesia 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.

Methods

Patients 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.

Results

Baseline 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.

Conclusions

Epidural 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.

Keywords Endometrial cancer; Hysterectomy; Epidural; Adverse events

Impact and interest:

5 citations in Scopus
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4 citations in Web of Science®

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ID Code: 65142
Item Type: Journal Article
Refereed: Yes
DOI: 10.1016/j.ygyno.2013.08.027
ISSN: 0090-8258
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Copyright Owner: Crown copyright © 2013
Copyright Statement: This is the author’s version of a work that was accepted for publication in Gynecologic Oncology. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Gynecologic Oncology, [VOL 131, ISSUE 2, (2013)] DOI: 10.1016/j.ygyno.2013.08.027
Deposited On: 06 Dec 2013 00:05
Last Modified: 07 Oct 2014 11:14

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