Effect of epidural anesthesia on anastomotic leakage in colonic surgery: experimental study

Abstract

BACKGROUND The association between the infusion of continuous epidural anesthesia and the anastomotic strength of colonic anastomosis was examined in an animal model. METHODS Fourteen white male New Zealand rabbits were included in the study and randomly assigned to two groups. Group 1 (n=7) had continuous epidural 0.9% Naa infusion (0.4 ml kg-1 bolus and 0.2 ml kg(-1) h(-1) infusion) and Group 2 (n=7) had continuous epidural 1% lidocaine infusion (0.4 ml kg(-1) bolus and 0.2 ml kg(-1) h(-1) infusion). Infusions started at the beginning of the operation and were continued for six hours postoperatively. All experimental animals underwent right colon resection and colo-colonic anastomosis under general anesthesia. On the fourth postoperative day, relaparotomy was applied and the bursting pressures of the anastomosis (BPA) were measured in situ. Segments 1-cm long consisting of the complete suture lines were excised, and the levels of hydroxyproline and collagen were measured. RESULTS BPAs were statistically higher in the epidural lidocaine group (median: 248 mmHg; min 117 - max 300) than in the saline group (median: 109 mmHg; min 47 - max 176) (p=0.006). There was no difference between the groups in terms of hydroxyproline and collagen levels in the sample tissues (p>0.05). CONCLUSION We concluded that the strength of colonic anastomosis may be increased by epidural lidocaine infusion.