Effectiveness of Postoperative Pain Management By Multimodal Analgesia Without Epidural Analgesia After Laparoscopic Colon Cancer Surgery: A Prospective Cohort Study

Background: Although epidural analgesia has been recommended for its strong analgesic effect for postoperative analgesia management, the increasing number of patients undergoing anticoagulant or antiplatelet therapy to treat cerebrocardiovascular diseases cannot receive epidural analgesia given the risk of serious complications, including epidural hematoma. We aimed to evaluate the analgesic effects of multimodal analgesia involving intravenous patient-controlled analgesia (IV-PCA), and repeated scheduled acetaminophen administration, and block as local anesthesia, to establish postoperative analgesia management method replacing epidural analgesia in laparoscopic colectomy. Methods: We enrolled patients undergoing laparoscopic surgery for colorectal cancer at our hospital. The primary outcome was days of postoperative hospital stay. The efficacies of multimodal and epidural analgesia were compared. The secondary outcomes were the pain assessment and safety. Results: We registered 48 patients; among them, 40 patients were eligible. The mean postoperative hospital stay was 9.00 days (95% CI = 8.19 to 9.39, p < 0.0001). There were relatively high pain scores from postoperative day (POD) 0-1, which subsequently decreased and reach their lowest value at POD 4-5. Conclusions: Multimodal analgesia with IV-PCA and repeated scheduled acetaminophen administration could provide a safe and effective analgesic effect after laparoscopic colectomy and may be a postoperative analgesia management alternative to epidural analgesia.