Comparative Analysis of Postoperative Analgesic Techniques within ERAS Protocol in Rectal Cancer Surgery. A Sub-analysis of a Large Cohort from Piedmont Region.

Enhanced Recovery After Surgery guidelines are progressively emerging as the gold standard strategy to reduce length of stay, decrease postoperative complications and improve patient satisfaction. In this context, we conducted a prospective, observational, multicenter study, that compared various postoperative standard intravenous analgesic techniques with locoregional ones, typical of the ERAS protocol, in order to better understand and present the benefits and pitfalls of each approach, in terms of occurrence of complications, patient satisfaction and enhancements in functional recovery. Among the evaluated parameters, we primarily analyzed differences in length of stay (LOS), and then compared secondary outcomes such as postoperative vomiting, pain control, reintroduction of liquids and solids per os and the need for rescue opioids. A total of 27 centers in Piedmont participated in the study, for a total sum of 779 patients. Overall, ERAS based postoperative analgesic techniques are generally associated with a more favorable outcome for each item considered. Locoregional analgesia methods are notably linked with an expedited postoperative recovery in terms of factors like patient mobility, independence, catheter removal, resumption of eating, and hydration when contrasted with exclusively intravenous analgesia. Additionally, they contribute to a reduction in the duration of hospital stays. Both epidural and spinal analgesia stand out for their effectiveness in managing pain when compared to intravenous analgesia and the TAP Block approach. Notably, epidural anesthesia yields the lowest Numeric Rating Scale (NRS) scores for post-operative pain and substantially diminishes the need for rescue doses of opioids in comparison to alternative techniques. Some outliers are although represented, for instance, by a lower incidence of episodes of vomit and acute urinary retention in the patient groups which were administered intravenous analgesia.