Spinal anesthesia in laparoscopic colorectal surgery: analgesia and recovery outcomes - a cohort study and systematic review of randomized controlled studies.

introductionSpinal anesthesia has been increasingly discussed as an adjunct to general anesthesia in laparoscopic colorectal surgery due to its potential to enhance early analgesia and reduce opioid exposure. Whether these benefits translate into improved postoperative bowel recovery remains unclear, and existing evidence is limited by heterogeneous study designs and small sample sizes. This study combines prospective cohort data with a systematic review and meta-analysis of randomized controlled trials to evaluate the effects of spinal anesthesia on pain, opioid use, and bowel function.

methodsAll consecutive patients undergoing elective laparoscopic colorectal resection without ostomy formation between October 2021 and December 2024 were included in a prospective cohort and offered spinal anesthesia. Outcomes were compared between patients receiving spinal anesthesia and controls managed with general anesthesia alone. Primary endpoints were postoperative bowel recovery (time to flatus, stool, full oral diet) and prolonged postoperative ileus. Secondary endpoints included pain scores, opioid consumption, length of stay and postoperative complications. META-ANALYSIS: A systematic search of Medline (Ovid), EMBASE, CINAHL, the Cochrane Library, Web of Science and Scopus from inception to October 2023 identified randomized controlled trials comparing colorectal surgery with and without single-shot spinal anesthesia. Outcomes of interest included time to oral diet, flatus and stool, pain scores at 24 h, opioid use within 24 h and length of hospital stay. Meta-analyses were performed using random-effects models.

resultsA total of 242 patients were included in the cohort (153 with spinal anesthesia, 89 controls). Spinal anesthesia resulted in markedly reduced early opioid use and lower pain scores within the first 12 h postoperatively (e.g., NRS 0-3 h: 0 vs. 4, p < 0.001). However, time to flatus, stool and full oral diet were comparable between groups, and the incidence of prolonged postoperative ileus remained low and similar (5% vs. 6%). Major postoperative complications were the only independent predictor of prolonged ileus in multivariate analysis (OR 8.55, p = 0.001). The meta-analysis included five randomized trials comprising 338 patients. Spinal anesthesia was consistently associated with reduced pain at 24 h (SMD: -0.749, 95% CI -1.219 to -0.279, p-value: 0.002) and lower opioid requirements within 24 h (SMD: -1.994, 95% CI -2.315 to -1.673, p-value < 0.001); respectively but showed no significant effect on postoperative bowel recovery or length of stay.

conclusionsAcross both prospective cohort data and randomized evidence, spinal anesthesia offers clear early analgesic benefits and reduces postoperative opioid use in laparoscopic colorectal surgery, but does not improve bowel recovery or reduce prolonged postoperative ileus. Prolonged ileus is driven mainly by major postoperative complications rather than analgesic modality. Spinal anesthesia should therefore be viewed as a safe and effective analgesic adjunct rather than a means to influence gastrointestinal recovery.