Article Text

Download PDFPDF
Role of regional anesthesia and analgesia in enhanced recovery after colorectal surgery: a systematic review of randomized controlled trials
  1. Kariem El-Boghdadly1,2,
  2. James M Jack1,
  3. Aine Heaney1,
  4. Nick D Black3,
  5. Marina F Englesakis4,
  6. Henrik Kehlet5 and
  7. Vincent W S Chan6
  1. 1 Department of Anaesthesia and Perioperative Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
  2. 2 Centre for Human and Applied Physiological Sciences, King’s College London, London, UK
  3. 3 Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
  4. 4 Library and Information Services, University Health Network, Toronto, Ontario, Canada
  5. 5 Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark
  6. 6 Department of Anesthesiology and Pain Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
  1. Correspondence to Dr Kariem El-Boghdadly, Department of Anaesthesia and Perioperative Medicine, Guy’s and St Thomas’ NHS Foundation Trust, SE1 9RT, London, UK; elboghdadly{at}


Background Effective analgesia is an important element of enhanced recovery after surgery (ERAS), but the clinical impact of regional anesthesia and analgesia for colorectal surgery remains unclear.

Objective We aimed to determine the impact of regional anesthesia following colorectal surgery in the setting of ERAS.

Evidence review We performed a systematic review of nine databases up to June 2020, seeking randomized controlled trials comparing regional anesthesia versus control in an ERAS pathway for colorectal surgery. We analyzed the studies with successful ERAS implementation, defined as ERAS protocols with a hospital length of stay of ≤5 days. Data were qualitatively synthesized. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool.

Findings Of the 29 studies reporting ERAS pathways, only 13 comprising 1170 patients were included, with modest methodological quality and poor reporting of adherence to ERAS pathways. Epidural analgesia had limited evidence of outcome benefits in open surgery, while spinal analgesia with intrathecal opioids may potentially be associated with improved outcomes with no impact on length of stay in laparoscopic surgery, though dosing must be further investigated. There was limited evidence for fascial plane blocks or other regional anesthetic techniques.

Conclusions Although there was variable methodological quality and reporting of ERAS, we found little evidence demonstrating the clinical benefits of regional anesthetic techniques in the setting of successful ERAS implementation, and future studies must report adherence to ERAS in order for their interventions to be generalizable to modern clinical practice.

PROSPERO registration number CRD42020161200.

  • outcomes
  • regional anesthesia
  • pain management

Data availability statement

No data are available.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

No data are available.

View Full Text


  • Twitter @elboghdadly, @nickdblack

  • Contributors Study design: KE-B, VWSC. Study conduct: KE-B, JMJ, AH, NDB, MFE. Manuscript preparation: KE-B, JMJ. Manuscript review: KE-B, JMJ, AH, NDB, MFE, HK, VWSC. Manuscript revisions: KE-B, JMJ, HK, VWSC. Guarantor: KE-B.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Linked Articles