Understanding the Perioperative Perception of Pain in Patients with Crohn's Disease: Epidural Versus Non-Epidural Analgesia

Abstract

Background: Patients with Crohn's disease (CD) suffer from a relevant burden of abdominal pain and psychological distress that can aggravate postoperatively. While systematic strategies for postoperative pain management are lacking, the potential benefit of perioperative epidural analgesia (EDA) in CD patients is unclear. Methods: All patients receiving an ileocecal resection due to CD at a tertiary hospital were included. The impact of epidural versus non-epidural analgesia on postoperative pain perception was evaluated by analyzing the numeric rating scale (NRS), analgesic consumption, and clinical outcomes. Results: In this monocentric study, 172 patients receiving ileocecal resection due to CD were included, with 122 receiving EDA. The epidural pain catheters were kept for an average of 4.4 days (±1.3) before being removed. EDA resulted in significantly decreased pain as well as a decreased amount of analgesic consumption (adjuvant analgesics: 16.4% vs. 32%, p = 0.021; strong opioids: 30.3% vs. 72.0%, p < 0.001) at the early postoperative course (1 vs. 3 at rest and 2 vs. 4 movement-evoked, p < 0.001). No difference in pain perception was detected on day 5 between EDA and non-EDA patients. Patients with EDA had a significantly longer length of hospital stay (7.5 versus 6 days, p = 0.002) and an increased intake of weak opioids at discharge (p = 0.024). Conclusions: While EDA in CD patients resulted in significantly decreased pain and decreased amounts of analgesic adjuvants and strong opioids at the early postoperative course, intravenous and oral analgesia provide sufficient postoperative pain control after surgery and earlier patient autonomy.

Keywords: Crohn’s disease; colorectal surgery; pain management; perioperative medicine.

Figure 1

Perception of pain on postoperative day 1 (PAR: p < 0.001, MEP: p < 0.001) (A) and day 5 (PAR: p = 0.533, MEP: p = 0.270) (B), measured with NRS compared between patients with intravenous analgesia alone and patients with combined analgesia (epidural pain catheter and intravenous analgesia). PAR = pain at rest. MEP = movement-evoked pain. EDA = epidural analgesia. NRS = numeric rating scale. * = statistical significantly different.

Figure 2

Analgesic score compared between patients with intravenous analgesia alone and patients with combined analgesia (epidural pain catheter and intravenous analgesia) on postoperative day 3 (p * < 0.001), on day 5 (p = ns), and at discharge (p = ns). EDA = epidural analgesia.