Incidence and associated factors of perioperative hypothermia in adult patients at a university-based, tertiary care hospital in Thailand.

BACKGROUND: Inadvertent perioperative hypothermia is an unintentional drop in core body temperature to less than 36 °C perioperatively and is associated with many negative outcomes such as infection, a prolonged stay in a recovery room, and decreased patient comfort. OBJECTIVE: To determine the incidence of postoperative hypothermia and to identify the associated factors with postoperative hypothermia in patients undergoing head, neck, breast, general, urology, and vascular surgery. The incidences of pre- and intraoperative hypothermia were examined as the intermediate outcomes. MATERIALS AND METHODS: A retrospective chart review was conducted in adult patients undergoing surgery at a university hospital in a developing country for two months (October to November 2019). Temperatures below 36 °C were defined as hypothermia. Univariate and multivariate analyses were used to identify factors associated with postoperative hypothermia. RESULTS: A total of 742 patients were analyzed, the incidence of postoperative hypothermia was 11.9% (95% CI 9.7%-14.3%), and preoperative hypothermia was 0.4% (95% CI 0.08%-1.2%). Of the 117 patients with intraoperative core temperature monitoring, the incidence of intraoperative hypothermia was 73.5% (95% CI 58.8-90.8%), and hypothermia occurred most commonly after anesthesia induction. Associated factors of postoperative hypothermia were ASA physical status III-IV (OR = 1.78, 95%CI 1.08-2.93, p = 0.023) and preoperative hypothermia (OR = 17.99, 95%CI = 1.57-206.89, p = 0.020). Patients with postoperative hypothermia had a significantly longer stay in the PACU (100 min vs. 90 min, p = 0.047) and a lower temperature when discharged from PACU (36.2 °C vs. 36.5 °C, p < 0.001) than those without hypothermia. CONCLUSION: This study confirms that perioperative hypothermia remains a common problem, especially in the intraoperative and postoperative periods. High ASA physical status and preoperative hypothermia were associated factors of postoperative hypothermia. In order to minimize the incidence of perioperative hypothermia and enhance patient outcomes, appropriate temperature management should be emphasized in patients at high risk. REGISTRATION: Clinical Trials.gov (NCT04307095) (13/03/2020).

A randomized controlled trial of preoperative carbohydrate drinks on postoperative walking capacity in elective colorectal surgery.

BACKGROUND AND OBJECTIVES: Routine overnight fasting may increase the risk of postoperative complications and delay postoperative recovery. Oral carbohydrate drinks have been shown to reduce glucose utilization and postoperative negative nitrogen balance while preserving muscle mass and strength. This randomized controlled trial aimed to examine whether preoperative oral carbohydrate drinks can enhance postoperative physical recovery in patients undergoing major colorectal surgery. METHODS AND STUDY DESIGN: Seventy patients were randomly assigned to receive either a 12.5% oral carbohydrate drink or pure water. Patients in both groups received 800- mL of one of the drinks on the evening before surgery, and another 400-mL drink on the morning of the operative day. The primary outcomes were the distances covered in 2-minute-walk tests at 24, 48 and 72-hours and 6- minute walk tests at 7-10 days postoperatively. The secondary outcomes were the postoperative serum insulin and glucose concentrations, nitrogen balance, duration of hospital stay, and the patient satisfaction scores. RESULTS: There were no significant differences in the characteristics of the two patients-groups. The postoperative 2-minute and 6-minute walk test distances, serum insulin and glucose concentrations of both groups were not statistically different. Patients receiving carbohydrate drink had more positive nitrogen balance than the control group. The duration of hospital stay and patient satisfaction scores were similar for both-groups. CONCLUSIONS: There were no statistically significant differences in the postoperative walking capacities of patients receiving a carbohydrate drink or pure water; only the nitrogen balance on postoperative day 3 was higher for patients receiving the carbohydrate drink.

Effectiveness of Postoperative Epidural Analgesia for Thoracic and Abdominal Surgery in Siriraj Hospital.

BACKGROUND: Epidural analgesia is the recommended analgesic technique in patients having surgery with moderate to severe postoperative pain. Inadequate pain control in patients receiving epidural analgesia frequently occurred in clinical practice but the number of the success rate or the failure rate have not been reported in our university hospital. OBJECTIVE: The aim of the prospective descriptive study is to examine various data related to and evaluate the effectiveness of the postoperative epidural analgesia in Siriraj Hospital, a university hospital in Thailand. MATERIAL AND METHOD: Patients scheduled to have elective thoracic or abdominal surgery under general anesthesia combined with epidural analgesia from December 2014 to October 2015 were enrolled in this study. Three hundred and sixty-four patients were finally analyzed. All data about demographics, surgery, epidural techniques, postoperative pain scores at rest and on movement, and postoperative complications were collected RESULTS: The number of patients having acceptable postoperative pain score at rest at all time period was 51.4%, (95% CI 46.3-56.5). Fifty patients (13.7%) in this group needed intravenous rescue medication for breakthrough pain. The incidence of severe postoperative pain at rest during running of epidural medication was 24.5% (95% CI 20.3-29.1). One hundred patients (27.5%) experienced postoperative nausea and vomiting; and 28 patients (7.7%) had episodes of hypotension. The incidences of accidental dural puncture and post-dural puncture headache were 1.36% and 0.8%, respectively. CONCLUSION: Inadequate postoperative analgesia with epidural technique occurred in up to 50% of patients in this study in which the rescue pain medication was necessary. In-depth analysis to identify associated factors to improve the effectiveness of postoperative epidural analgesia should be further investigated.

Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study.

BACKGROUND: Patients undergoing colorectal cancer resections are at risk for delayed recovery. Prehabilitation aims to enhance functional capacity preoperatively for better toleration of surgery and to facilitate recovery. The authors previously demonstrated the limited impact of a prehabilitation program using exercise alone. They propose an expanded trimodal prehabilitation program that adds nutritional counseling, protein supplementation, and anxiety reduction to a moderate exercise program. This study aimed to estimate the impact of this trimodal program on the recovery of functional capacity compared with standard surgical care. METHODS: Consecutive patients were enrolled in this pre- and postintervention study over a 23-month period. The postoperative recovery for 42 consecutive patients enrolled in the prehabilitation program was compared with that of 45 patients assessed before the intervention began. The primary outcome was functional walking capacity (6-min walk test [6MWT]). The secondary outcomes included self-reported physical activity (CHAMPS questionnaire) and health-related quality of life (SF-36). Data are expressed as mean ± standard deviation or median (interquartile range [IQR]) and were analyzed using Chi-square and Student's t test. All p values lower than 0.05 were considered significant. RESULTS: The prehabilitation and control groups were comparable in terms of age, gender, body mass index (BMI) and American Society of Anesthesiology (ASA) class. There was no difference in walking capacity at the first assessment (6MWT distance, 422 ± 87 vs 402 ± 57 m; p = 0.21). During the prehabilitation period lasting a median of 33 days (range, 21-46 days), functional walking capacity improved by 40 ± 40 m (p < 0.01). The postoperative complication rates and the hospital length of stay were similar. The patients in the prehabilitation program had better postoperative walking capacity at both 4 weeks (mean difference, 51.5 ± 93 m; p = 0.01) and 8 weeks (mean difference, 84.5 ± 83 m; p < 0.01). At 8 weeks, 81 % of the prehabilitated patients were recovered compared with 40 % of the control group (p < 0.01). The prehabilitation group also reported higher levels of physical activity before and after surgery. CONCLUSION: In this pilot study, a 1-month trimodal prehabilitation program improved postoperative functional recovery. A randomized trial is ongoing (NCT01356264).

The impact of a preanesthesia assessment clinic on scheduled elective case cancelations at a Thai university hospital.

Elective surgical case cancelations negatively impact healthcare systems and patient dissatisfaction. Preanesthesia assessment clinics (PACs) have been established in many countries to facilitate preoperative medical optimization. However, their benefits for elective procedure cancelations in Thailand have not been formally assessed. This study evaluated the impact of a PAC on scheduled elective surgical case cancelations at a Thai university hospital. A retrospective cross-sectional study was conducted for the period covering from May 2016 to April 2017. We included all scheduled elective surgical cases at Siriraj Hospital, Thailand, canceled on the day of surgery. The cancelation incidences of patients attending and not attending the PAC were compared. Cancellation reasons were categorized as "patient issue," "hospital-facility issue," "surgeon issue," "anesthesiologist issue," "medical condition," and "miscellaneous." The PAC patients' reasons were rigorously explored to determine their preventability. There were 30,351 scheduled elective procedures during the study period. The case-cancelation incidences were 0.9% (95% confidence interval [CI], 0.7-1.2%) for patients visiting the PAC and 5.9% (95% CI, 5.6-6.3%) for those who did not. Medical conditions were the most common reason for cancelation for non-PAC patients (27.3%), whereas hospital-facility issues were the most frequent for PAC patients (43.8%). The cancelation rate for patient issues was significantly lower in the PAC group (4.2% vs 20.7%; P < .05). Thirty-one (64.6%) of the PAC patients' cancelations were potentially preventable. Of the 15 PAC patient cancelations related to medical conditions, 12 were for patients with a history of acute illness and were determined to be nonpreventable. Visiting the PAC was significantly associated with a decreased elective-case cancelation rate. Cancellations were most frequently related to hospital-facility issues for patients visiting the PAC and medical conditions for those who did not. Some PAC patient cancelations for medical conditions involved unpreventable acute patient illnesses. Clinical Trials.gov (NCT02816281).

Incidence, risk factors and outcomes of early post-operative stroke in a university-based, tertiary care hospital: A 7-year retrospective case-control study.

Most post-operative stroke cases occur within 24 hours. This retrospective case-control study aimed to investigate the incidence, risk factors, and outcomes of early post-operative stroke that occurred within 24 hours after surgery in a university-based tertiary care hospital. Medical records were collected and reviewed between 2015 and 2021. Early post-operative stroke cases were compared with age-matched controls in a 1:3 ratio, and data regarding patient characteristics, intra-operative events, and post-operative outcomes were analyzed. Multiple logistic regression was performed to identify the risk factors for post-operative stroke. The incidence of early (≤24 hours) post-operative stroke was 0.015% (43 out of 284,105 cases). The multivariable analysis revealed that American Society of Anesthesiologists (ASA) physical status ≥3 (adjusted odds ratio [OR]: 3.12; 95% confidence interval [CI]: 1.22-7.99, P = .017), operation time >120 minutes (adjusted OR: 10.69; 95% CI: 3.95-28.94, P < .001), and intra-operative hypotension and inotrope/vasopressor use (adjusted OR: 2.80; 95% CI: 1.08-7.24, P = .034) were risk factors for early post-operative stroke. Compared to the controls, stroke patients had higher rates of planned and unplanned intensive care unit (ICU) admission, length of stay, ventilator use, and death. Despite its low incidence (0.015%), stroke is associated with poor clinical outcomes and increased mortality. Stratification of potential risks and establishment of risk optimization may help reduce stroke incidence.

A randomized controlled trial comparing incidences of postoperative nausea and vomiting after laparoscopic cholecystectomy for preoperative intravenous fluid loading, ondansetron, and control groups in a regional hospital setting in a developing country.

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common complication in inpatient and outpatient settings. Multimodal approaches have been pursued to minimize this undesirable outcome. Despite consensus guidelines for the management of PONV have been updated and published for many years, data from our pilot study showed that patients with high-risk surgeries for PONV, laparoscopic cholecystectomy (LC), still hardly received perioperative PONV prophylaxis. This study aimed to compare the incidences of PONV in adult patients undergoing elective LC who were administered preoperative intravenous fluid loading, ondansetron, or neither fluid nor ondansetron in the setting of a regional hospital in a developing country. METHODS: The study was designed as a prospective randomized controlled trial. The total of 171 patients was allocated to three groups: one received fluid loading with Ringer's lactate solution before the operation; the second received ondansetron; and the third group received neither. RESULTS: In total, 156 patients were analyzed. Their demographic data, history of motion sickness/PONV, and smoking status were not significantly different. The overall incidences of PONV within 24 hours of surgery were 29.1% in the fluid group, 18.4% in the ondansetron group, and 25% in the control group, but the difference was not statistically significant (P = .442). In subgroup analysis, the incidences of PONV and PON in patients younger than 50 years old were significantly different among the three groups (P = .008). A post hoc analysis showed that patients under 50 years in the ondansetron group had significantly lower incidences of PONV and PON than those in the control and fluid groups. However, the incidences of morphine consumption and dizziness in the ondansetron group were significantly higher than those of the two other groups. CONCLUSIONS: Neither the preoperative intravenous fluid loading nor the ondansetron affected PONV in patients aged 50 and older undergoing LC, compared with control. Ondansetron was beneficial for PON prophylaxis in patients under the age of 50, whereas preoperative intravenous fluid loading was considered a risk factor for PON in this population.

A simpler screening tool for sarcopenia in surgical patients.

BACKGROUND: Sarcopenia is defined as decreased skeletal muscle mass and muscle functions (strength and physical performance). Muscle mass is measured by specific methods, such as bioelectrical impedance analysis and dual-energy X-ray absorptiometry. However, the devices used for these methods are costly and are usually not portable. A simple tool to screen for sarcopenia without measuring muscle mass might be practical, especially in developing countries. The aim of this study was to design a simple screening tool and to validate its performance in screening for sarcopenia in older adult cancer patients scheduled for elective surgery. METHODS: Cancer surgical patients aged >60 years were enrolled. Their nutritional statuses were evaluated using the Mini Nutrition Assessment-Short Form. Sarcopenia was assessed using Asian Working Group for Sarcopenia (AWGS) criteria. Appendicular skeletal muscle mass was measured by bioelectrical impedance analysis. Four screening formulas with differing combinations of factors (muscle strength, physical performance, and nutritional status) were assessed. The validities of the formulas, compared with the AWGS definition, are presented as sensitivity, specificity, accuracy, and area under a receiver operating characteristic curve. RESULTS: Of 251 enrolled surgical patients, 84 (34%) were diagnosed with sarcopenia. Malnutrition (odds ratio [OR]: 2.89, 95% CI: 1.40-5.93); underweight status (OR: 2.80, 95% CI: 1.06-7.43); and age increments of 5 years (OR: 1.78, 95% CI: 1.41-2.24) were independent predictors of preoperative sarcopenia. The combination of low muscle strength and/or abnormal physical performance, plus malnutrition/risk of malnutrition had the highest sensitivity, specificity, and accuracy (81.0%, 78.4%, and 79.3%, respectively). This screening formula estimated the probability of sarcopenia with a positive predictive value of 65.4% and a negative predictive value of 89.1%. CONCLUSION: Sarcopenia screening can be performed using a simple tool. The combination of low muscle strength and/or abnormal physical performance, plus malnutrition/risk of malnutrition, has the highest screening performance.

Postoperative clinical outcomes and inflammatory markers after inguinal hernia repair using local, spinal, or general anesthesia: A randomized controlled trial.

BACKGROUND: No consensus has yet been reached regarding the best anesthetic technique for inguinal hernia repair. This study aimed to compare postoperative clinical outcomes and inflammatory markers among patients who were anesthetized using local, spinal, or general anesthesia for inguinal hernia repair. METHODS: This randomized controlled trial included patients scheduled to undergo elective unilateral inguinal hernioplasty at Siriraj Hospital during November 2014 to September 2015 study period. Patients were randomly assigned to the local (LA), spinal (SA), or general (GA) anesthesia groups. Primary outcomes were postoperative pain at rest and on mobilization at 8 and 24 hours after surgery. RESULTS: Fifty-four patients were included, with 18 patients randomly assigned to each group. Patient demographic and clinical characteristics were similar among groups. There were no significant differences among groups for postoperative pain at rest or on mobilization at 8 and 24 hours after surgery. No significant differences were observed for interleukin-1ß, interleukin-6, and interleukin-10 at any time points in any groups. Patients with local anesthesia was associated with less time spent in anesthesia (p = 0.010) and surgery (p = 0.009), lower intraoperative cost (p = 0.003) and total cost in hospital (p = 0.036); however, patient satisfaction in the local anesthesia group (94/100) was statistically significantly lower than the spinal and general anesthesia groups (100/100) (p = 0.010). CONCLUSIONS: No statistically significant difference was observed among groups for postoperative pain scores, duration of hospital stays, complications, or change in inflammatory markers. However, time spent in anesthesia and surgery, the intraoperative cost and total cost for hernia repair, and patient satisfaction were significantly lower in the local anesthesia group than in the other two groups.

Deep neuromuscular blockade for endolaryngeal procedures: A multicenter randomized study.

OBJECTIVES/HYPOTHESIS: The aim of the present study was to compare the surgical condition between deep neuromuscular blockade (NMB) and moderate NMB. STUDY DESIGN: Multicenter, randomized, parallel intervention trial. METHODS: One hundred two patients underwent microscopic endolaryngeal surgery at four university hospitals. The patients were randomized into moderate NMB (train-of-four 1-2) (M group) or deep NMB (post-tetanic count 1-2) (D group) with moderate or high doses of rocuronium, respectively. Surgical rating conditions (SRCs) were evaluated during the surgery. Sugammadex was given to the M group at 2 mg/kg and the D group at 4 mg/kg. Perioperative clinical signs and conditions were recorded until discharge from the postanesthesia care unit. RESULTS: Clinically acceptable SRC was observed in 49 patients (100%) in the D group and 43 patients (89.6%) in the M group (P = .027). The frequency of notable vocal fold movement in the M group was significantly higher than the D group (70.8% vs. 32.7%). The patients in the M group required more additional doses of rocuronium (47.9%) than the D group (20.4%) to maintain full relaxation (P = .005). The median time (interquartile range) from administration of sugammadex to train-of-four ratio 0.9 in the D group was shorter than the M group (120 [109-180 minutes] vs. 180 minutes [120-240 minutes], P = .034). CONCLUSIONS: Deep NMB with high doses of rocuronium combined with 4 mg/kg of sugammadex for reversal during endolaryngeal surgery provided better SRC and anesthetic conditions than moderate NMB of rocuronium with 2 mg/kg of sugammadex. LEVEL OF EVIDENCE: 1b Laryngoscope, 130:437-441, 2020.

Use of rapid ABG analyzer in measurement of potassium concentration: does it agree with venous potassium concentration?

BACKGROUND: Because extreme venous potassium abnormality can be life threatening, rapid measurement of potassium level is essential. Traditional biochemical analysis for venous potassium takes time and delays management in seriously ill patients. Analysis form arterial blood gas (ABG) may be an alternative method that is faster. OBJECTIVE: To determine agreement between potassium obtained from venous and arterial blood gas in emergency patients, Siriraj Hospital. MATERIAL AND METHOD: Cross-sectional study performed in 53 patients who presented to the emergency department of Siriraj Hospital. Potassium level measured from ABG was compared to venous route. RESULTS: The mean of venous, arterial potassium and difference between each pair were 3.95, 3.46, and 0.49 mmol/L respectively. The Intraclass Correlation Coefficient between each pair of two methods and 95% CI of agreement were 0.904 and 0.839 to 0.943, p < 0.01. CONCLUSION: The agreement between ABG and venous potassium measurement are confirmed Clinicians can use ABG's potassium level as a guideline for treatment instead of using the conventional venous potassium level.

The effectiveness of intravenous sedation in diagnostic upper gastrointestinal endoscopy.

BACKGROUND: Topical pharyngeal anesthesia is required to perform a technically adequate esophago-gastroduodenoscopy (EGD), but does not improve patient satisfaction, comfort, and willingness to repeat, particularly in the elderly and those with increased pharyngeal sensitivity. The comparative effectiveness of intravenous sedation versus no sedation remains poorly characterized. OBJECTIVE: To compare the effectiveness of diagnostic EGD with and without intravenous sedation in an adult Thai population. MATERIAL AND METHOD: A randomized controlled trial assigned patients into two groups, group C (topical pharyngeal anesthesia alone) and group I (intravenous sedation and topical pharyngeal anesthesia). All patients were topicalized with lidocaine viscous and spray. The patients in group I were sedated with midazolam 0.035 mg x kg(-1) and maintained with continuous propofol infusion. The ease of procedure and patient tolerance were evaluated. Secondary outcomes included patient and endoscoptist satisfaction, total time to awake, and willingness to repeat the procedure. RESULTS: One hundred and seventy patients (mean age 50.5, 41.2% male) were randomized (group C = 85 and group I = 85; intervention) into two groups. Among patients of the two groups, 100% of the procedures were "successful". In group C, 98.8% were satisfied with their level of tolerance (comfort) while the group I had 100%. The willingness to repeat was 6.2 +/- 1.6 in group C while group I had 9.4 +/- 0.8. Patient and endoscopist satisfaction in group I was more satisfied than in group C (90.6% vs 35.3% and 81.2% vs 40.0% respectively) (p < 0.001). In group I, total amount of propofol was 91.6 +/- 45.5 mg and total time to awake was 8.2 +/- 4.2 min. The use of sedation was the major determinant of patient satisfaction, but contributed to an increased recovery room time. Hypertension and tachycardia were the most complications in group C, and hypotension was the most complication in group I. CONCLUSION: In the average Thai adult population, sedated diagnostic EGD is a good strategy to increase endoscopist satisfaction and willingness to repeat.

Single-port laparoscopic colorectal surgery: early clinical experience.

BACKGROUND: Single-port laparoscopic surgery (SPLS) for colorectal pathology is an advanced technique wherein laparoscopic surgery is carried out through a single small incision hidden in the umbilicus. Advantages of this technique over standard laparoscopy are still under investigation. This study reports the initial experience and short-term outcomes of colorectal SPLS procedures in a single academic-based institution. SUBJECTS AND METHODS: All patients who underwent SPLS for colorectal procedures between February 2010 and March 2011 were recruited into this prospective study. Patients' demographics, pathology, and intraoperative and postoperative outcomes were collected. Time to first flatus and bowel movement, postoperative pain, duration of hospital stay, and complications were also measured. RESULTS: Twenty patients underwent colorectal SPLS: 17 patients underwent right hemicolectomy, and 3 patients had sigmoid resection. Mean age was 66±14 years, and body mass index was 25±4 kg/m(2). Median operative time for right hemicolectomy was 120 minutes (range, 110-136 minutes), and that for sigmoid resection was 158 minutes (range, 86-177 minutes). Mean measured incision length was 4.2±1.2 cm (range, 2.5-7 cm). Two cases were converted to standard multiport laparoscopy, and 1 was converted to open surgery Postoperatively, there was no mortality. Intra-abdominal abscess was observed in 3 patients. Median postoperative stay was 3 days (range, 3-3 days). Median number of lymph nodes extracted was 15 (range, 12-23). CONCLUSIONS: The SPLS is technically feasible with proper patient selection for a variety of applications in colorectal surgery. Improvement in instrumentation and technology is likely to expand the role of SPLS in minimally invasive surgery. It is important to audit outcomes as this novel approach is introduced.

Feasibility of modified surviving sepsis campaign guidelines in a resource-restricted setting based on a cohort study of severe S. aureus sepsis [corrected].

BACKGROUND: The Surviving Sepsis Campaign (SSC) guidelines describe best practice for the management of severe sepsis and septic shock in developed countries, but most deaths from sepsis occur where healthcare is not sufficiently resourced to implement them. Our objective was to define the feasibility and basis for modified guidelines in a resource-restricted setting. METHODS AND FINDINGS: We undertook a detailed assessment of sepsis management in a prospective cohort of patients with severe sepsis caused by a single pathogen in a 1,100-bed hospital in lower-middle income Thailand. We compared their management with the SSC guidelines to identify care bundles based on existing capabilities or additional activities that could be undertaken at zero or low cost. We identified 72 patients with severe sepsis or septic shock associated with S. aureus bacteraemia, 38 (53%) of who died within 28 days. One third of patients were treated in intensive care units (ICUs). Numerous interventions described by the SSC guidelines fell within existing capabilities, but their implementation was highly variable. Care available to patients on general wards covered the fundamental principles of sepsis management, including non-invasive patient monitoring, antimicrobial administration and intravenous fluid resuscitation. We described two additive care bundles, one for general wards and the second for ICUs, that if consistently performed would be predicted to improve outcome from severe sepsis. CONCLUSION: It is feasible to implement modified sepsis guidelines that are scaled to resource availability, and that could save lives prior to the publication of international guidelines for developing countries.

Intravenous lidocaine versus thoracic epidural analgesia: a randomized controlled trial in patients undergoing laparoscopic colorectal surgery using an enhanced recovery program.

BACKGROUND AND OBJECTIVE: Laparoscopy, thoracic epidural analgesia, and enhanced recovery program (ERP) have been shown to be the major elements to facilitate the postoperative recovery strategy in open colorectal surgery. This study compared the effect of intraoperative and postoperative intravenous (IV) lidocaine infusion with thoracic epidural analgesia on postoperative restoration of bowel function in patients undergoing laparoscopic colorectal resection using an ERP. METHODS: Sixty patients scheduled for elective laparoscopic colorectal surgery were prospectively randomized to receive either thoracic epidural analgesia (TEA group) or IV lidocaine infusion (IL group) (1 mg/kg per hour) with patient-controlled analgesia morphine for the first 48 hours after surgery. All patients received a similar ERP. The primary outcome was time to return of bowel function. Postoperative pain intensity, time out of bed, dietary intake, duration of hospital stay, and postoperative complications were also recorded. RESULTS: Mean times and SD (95% confidence interval) to first flatus (TEA, 24 [SD, 11] [19-29] hrs vs IL, 27 [SD, 12] [22-32] hrs) and to bowel movements (TEA, 44 ±19 [35-52] hrs vs IL, 43 [SD, 20] [34-51] hrs) were similar in both groups (P = 0.887). Thoracic epidural analgesia provided better analgesia in patients undergoing rectal surgery. Time out of bed and dietary intake were similar. Patients in the TEA and IL groups were discharged on median day 3 (interquartile range, 3-4 days), P = 0.744. Sixty percent of patients in both groups left the hospital on day 3. CONCLUSIONS: Intraoperative and postoperative IV infusion of lidocaine in patients undergoing laparoscopic colorectal resection using an ERP had a similar impact on bowel function compared with thoracic epidural analgesia.