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HOME > Ann Coloproctol > Volume 40(6); 2024 > Article
Editorial
 Optimizing postoperative pain management in minimally invasive colorectal surgery
Soo Young Leeorcid
Annals of Coloproctology 2024;40(6):525-526.
DOI: https://doi.org/10.3393/ac.2024.00815.0116
Published online: December 3, 2024

Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea

Correspondence to: Soo Young Lee, MD, PhD Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, 322 Seoyang-ro, Hwasun 58128, Korea Email: syleecrs@gmail.com
• Received: November 13, 2024   • Accepted: November 14, 2024

© 2024 The Korean Society of Coloproctology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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The adoption of Enhanced Recovery After Surgery (ERAS) protocols in colorectal surgery has significantly improved patient outcomes by reducing complications and accelerating recovery [1, 2]. ERAS protocols include multiple components that aim to maintain postoperative physiological function and reduce the surgical stress response, thus promoting faster recovery [3]. Effective postoperative pain control is a cornerstone of ERAS. Proper pain management after colorectal surgery is crucial, as it facilitates quicker recovery and enables earlier discharge.
For several decades, patient-controlled analgesia (PCA) has been the primary method for pain management, valued for its ease of use and reliable pain control [4]. However, PCA often relies on opioids, which can lead to side effects such as nausea and vomiting. Even when antiemetics are used, opioids may still impair gastrointestinal motility, potentially delaying recovery [1, 4]. Therefore, ERAS guidelines recommend reducing opioid use and adopting a multimodal analgesia approach, which involves combining 2 or more methods for pain control [1, 5]. Multimodal pain management options include cyclooxygenase-2 (COX-2) selective nonsteroidal anti-inflammatory drugs (NSAIDs), gabapentinoids, and nerve blocks such as transversus abdominis plane and rectus sheath blocks. Other strategies include continuous wound infiltration (CWI) with a catheter for local anesthetic delivery, and the use of thermosensitive hydrogel-based applications for local anesthetics [5–7].
The present study by Choi and Bae [8] investigated the effectiveness of CWI using ropivacaine combined with intravenous (IV) PCA for reducing postoperative opioid consumption and pain in patients undergoing reduced-port laparoscopic colorectal surgery. The addition of CWI significantly decreased pain scores on postoperative day 0 (3.2±0.8 vs. 3.7±0.9, P=0.042) and opioid requirements within the first 24 hours after surgery (0.7±0.9 vs. 1.3±1.1, P=0.018), highlighting the potential of CWI as part of multimodal analgesia in colorectal surgery. Notably, this study demonstrated the beneficial role of CWI when used in combination with IV PCA, a common practice. When IV PCA is employed, its integration with CWI could lead to reduced opioid consumption, offering a promising option for enhanced multimodal pain management.
CWI in laparoscopic colorectal surgery offers several advantages and some potential drawbacks. On the positive side, CWI can effectively alleviate postoperative pain, thereby reducing the reliance on opioids and minimizing their associated side effects [9, 10]. It has also been demonstrated to enhance patient satisfaction regarding pain management and to hasten the return of bowel function [9]. Additionally, CWI is relatively straightforward to administer and maintains a favorable safety profile [10]. However, its effectiveness in laparoscopic procedures appears less marked than in open surgery [9]. The insertion of catheters in minimally invasive surgery poses challenges that may impact the efficacy of CWI. Moreover, although CWI is generally considered safe, there remain concerns about wound healing and infection risks, though significant increases in these complications have not been documented [9, 10]. In summary, while CWI holds potential in laparoscopic colorectal surgery, its advantages may be more constrained compared to its application in open surgery, necessitating further research to refine its use in minimally invasive settings [9].
In conclusion, this study reinforces the importance of CWI within ERAS protocols, especially for minimally invasive colorectal procedures that necessitate effective postoperative pain management with minimal reliance on opioids. By decreasing opioid use and enhancing early pain control, CWI provides a safe and effective alternative to conventional analgesic methods, aligning closely with the goals of ERAS. As ERAS protocols continue to develop, incorporating advanced, localized pain management techniques could further improve outcomes, setting the stage for optimal recovery pathways in minimally invasive colorectal surgery.

Conflict of interest

Soo Young Lee is an Editorial Board member of Annals of Coloproctology, but was not involved in the peer reviewer selection, evaluation, or decision process of this article. No other potential conflict of interest relevant to this article was reported.

Funding

None.

  • 1. Irani JL, Hedrick TL, Miller TE, Lee L, Steinhagen E, Shogan BD, et al. Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum 2023;66:15–40. ArticlePubMedPMC
  • 2. Weets V, Meillat H, Saadoun JE, Dazza M, de Chaisemartin C, Lelong B. Impact of an enhanced recovery after surgery (ERAS) program on the management of complications after laparoscopic or robotic colectomy for cancer. Ann Coloproctol 2024;40:440–50. ArticlePubMedPMCPDF
  • 3. Gillis C, Ljungqvist O, Carli F. Prehabilitation, enhanced recovery after surgery, or both? A narrative review. Br J Anaesth 2022;128:434–48. ArticlePubMed
  • 4. Yeo J, Park JS, Choi GS, Kim HJ, Kim JK, Oh J, et al. Comparison of the analgesic efficacy of opioid-sparing multimodal analgesia and morphine-based patient-controlled analgesia in minimally invasive surgery for colorectal cancer. World J Surg 2022;46:1788–95. ArticlePubMedPDF
  • 5. Lee Ky, Lee SY, Choi M, Kim M, Kim JH, Song JM, et al. The 2024 Korean Enhanced Recovery After Surgery guidelines for colorectal cancer. Ann Clin Nutr Metab 2024;16:22–42. Article
  • 6. Wu CL, King AB, Geiger TM, Grant MC, Grocott MP, Gupta R, et al. American Society for Enhanced Recovery and Perioperative Quality Initiative joint consensus statement on perioperative opioid minimization in opioid-naïve patients. Anesth Analg 2019;129:567–77. ArticlePubMedPMC
  • 7. Kim JS, Lee CS, Bae JH, Han SR, Lee DS, Lee IK, et al. Clinical impact of a multimodal pain management protocol for loop ileostomy reversal. Ann Coloproctol 2024;40:210–6. ArticlePubMedPMCPDF
  • 8. Choi HD, Bae SU. Effect of continuous wound infiltration on patients using intravenous patient-controlled analgesia for pain management after reduced-port laparoscopic colorectal surgery. Ann Coloproctol 2023 Sep 15 [Epub]. https://doi.org/10.3393/ac.2023.00143.0020. Article
  • 9. Huang XZ, Zhao JH, Gao P, Chen XW, Song YX, Xu Y, et al. Continuous wound infiltration with local anesthetic is an effective and safe postoperative analgesic strategy: a meta-analysis. Pain Ther 2021;10:525–38. ArticlePubMedPMCPDF
  • 10. Zheng X, Feng X, Cai XJ. Effectiveness and safety of continuous wound infiltration for postoperative pain management after open gastrectomy. World J Gastroenterol 2016;22:1902–10. ArticlePubMedPMC

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        Optimizing postoperative pain management in minimally invasive colorectal surgery
        Ann Coloproctol. 2024;40(6):525-526.   Published online December 3, 2024
        DOI: https://doi.org/10.3393/ac.2024.00815.0116
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