Intra-operative oxygen delivery in infusion volume-optimized patients undergoing laparoscopic colorectal surgery within an enhanced recovery programme: the effect of different analgesic modalities

Aim Patients undergoing major open surgery who have an indexed oxygen delivery (DO₂I) > 600 ml/min/m² have been shown to have a lower incidence of morbidity and mortality compared with those whose DO₂I is below this level. Laparoscopy and Trendelenburg positioning cause a reduction in DO₂I. We aimed to quantify the effect of the type of analgesia on DO₂I and to correlate the DO₂I achieved with the incidence of anastomotic leakage in patients undergoing laparoscopic surgery. Method Following ethical approval, patients were randomized to receive spinal anaesthesia (Group S), epidural analgesia (Group E) or intravenous morphine (Group P) followed by postoperative patient‐controlled analgesia (PCA). In addition to standard monitoring, oesophageal Doppler monitoring of the stroke volume allowed directed intravenous fluid therapy. The mean DO₂I was compared with the anastomotic leakage rate. Results Seventy‐five patients were recruited (Group S, 27; Group E, 23; Group P, 25). The mean (range) DO₂I for all patients was 490 (230‐750) ml/min/m². The analgesic modality had no effect on DO₂I. Of the 18 patients with a DO₂I of < 400 ml/min/m², four (22%) developed anastomotic leakage compared with one (%) of the 57 patients with a DO₂I of > 400 ml/min/m² (P = 0.01). Conclusion The analgesic modality used had no effect on the DO₂I achieved. Anastomotic leakage was significantly higher in patients with a DO₂I of < 400 ml/min/m². A further study assessing the outcome after raising the DO₂I with inotropes is required.