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Epidural analgesia, gastrointestinal motitity and intestinal blood flow


--Thoracic (above the T12 dermatome) epidural local anesthetics (e.g. bupivacaine) can have clinically significant effects to decrease the duration of ileus after abdominal surgery.

--The most optimal post-op analgesia , in terms of minimizing post-op ileus, appears to be a combination of low-dose epidural bupivacaine plus morphine.

--In order for this combination to be effective, it should be delivered via a thoracic epidural catheter, ideally with the tip of the catheter as close as possible to the dermatome in the middle of the surgical incision. (e.g. T10 for an upper abdominal incision)


Safeguarding intestinal perfusion is a critical issue in the maintenance of intestinal function and integrity of the mucosal barrier.
The effect of epidural bupivacaine (5mg/ml) on intestinal blood flow was studied with laser Doppler flowmetry in patients during large bowel resection.
In the colon, blood flow increased in 13 out of 15 patients, which was significant at the 1 per cent level. The average increase was 41%.
(K. Johansson British Journal of Surgery 2005 Vol 75 Issue 1, P 73-76)


Epidural analgesia increased 7-day surival from 33% to 73% (p<0.05)
Thoracic epidural analgesia attenuated systemic response and improved survival in severe acute pancreatitis.
These effects might be explained by improved mucosal perfusion.
(Freise Hendrik Anesthesiology 2006; 105(2):354-9.)


After oesophagectomy, continuous infusion bupivacaine 10 ml/hr, increased the anastomotic mucosal blood flow.
(Michelet P et. al acta anesthesiol. Scan. 2007 51:587-94)


Thoracic epidural analgesia provides a significant benefit in terms of
*less analgesic consumption
*better post-op pain relief
*and faster recovery of gastrointestinal function
in patients undergoing laparoscopic colorectal resection
(ZINGG Urs 2009, vol 23, n2 pp. 276-282)
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