Post-operative analgesia is crucial in enhanced recovery after surgery and to minimize post-operative complications. There remains data paucity on the efficacy of preperitoneal analgesia (PPA) compared to patient-controlled analgesia (PCA). This study aims to examine the efficacy of preperitoneal infusion as analgesia following elective colorectal surgery.This is a prospective cross-sectional study of all patients which underwent elective colorectal surgeries, performed in a tertiary surgical referral center with dedicated colorectal unit. Patients from May 2017 to April 2021 who underwent elective colorectal surgery were included in this study. Pain scores were reviewed and analyzed at regular intervals post-operatively for comparison.Amongst the 200 patients included, there were 174 patients in the PPA arm and 26 patients using PCA. Patients in the PPA group were older age (63.29 vs 56.00, P = 0.003). A total of 118 patients in PPA cohort (67.8%) and 21 from PCA cohort (80.8%) underwent open surgery and the remaining 82 patients underwent laparoscopic surgeries. Although postoperative pain scores were consistently below 5 and reduced in trend from 2 hours to 96 hours postoperatively in both groups, the pain scores on coughing markedly reduced in the PPA group when compared PCA alone. The total dosage of opioid required in PPA cohort was also significantly lower when compared to PCA group at the first 24 hours postoperatively 12.21 (±13.0) vs 20.0 (±14.43), P = 0.048.PPA is a comparable modality for analgesia after elective colorectal surgery that reduces the opioid requirement postoperatively giving adequate pain relief. PPA should be considered as an alternative modality for multi-modal analgesia.
Introduction: Multimodal analgesia regime in enhanced recovery after surgery (ERAS) protocol is associated with fewer perioperative complications, shorter hospital stays, and reduced opioid dependence. Although ERAS strategies have been widely accepted and implemented in current practice, there is limited data regarding its application and outcomes in the Malaysian population, particularly in colorectal surgeries. Hence, this study was conducted to examine postoperative pain scores after implementing a multimodal analgesia regime as per ERAS anaesthesia protocol. Methods: This is a retrospective study using data collection forms. Data were collected from the case notes of patients who underwent colorectal surgery complying with the ERAS anaesthesia protocol from January 2022 to December 2023. Pain score was assessed when the patient arrived at recovery bay, subsequently reassessed at 2 hours postoperative, 6 hours postoperative, 12 hours postoperative, 1 day postoperative, and finally on postoperative day 2. Results: A total of 139 samples were recruited in this retrospective study. The median postoperative pain scores at rest were consistently 0 from arrival at recovery bay to postoperative day 2. On the other hand, the median pain score upon movement was 1 (range 0–3) when patients reached the recovery bay, and persistently 3 duringpostoperative 2 hours, 6 hours, and 12 hours, after which the median pain score upon movement became 2 on postoperative day 1 and day 2. Conclusions: Multimodal analgesia in line with the ERAS protocol in colorectal surgeries is feasible, safe and efficient.
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