Not recommended for open and laparoscopic colonic resection

Not recommended for open and laparoscopic colonic resection

Pre-operative not recommended	Systemic analgesia  IV clonidine (Grade D) because it is associated with an increased risk of hypotension and bradycardia Conventional NSAIDs (Grade B) because pre-operative administration of these agents can increase the risk of intra- and postoperative bleeding Corticosteroids for analgesia (Grade A) because of procedure-specific evidence showing no significant benefit in reducing pain scores and concerns that they could affect anastomotic and wound integrity (but they may be used for reduction of PONV) Gabapentin/pregabalin (Grade D) due to a lack of procedure-specific evidence Continuous administration of IV lidocaine limited to the pre-/intra-operative period (Grade D) because of inconsistent and insufficient procedure-specific evidence NMDA receptor antagonists (Grade D) because of limited procedure-specifc evidence Strong opioids (Grade B) as they are significantly less effective than postoperative strong opioids for reducing postoperative pain Weak opioids (Grade B) based on procedure-specific evidence that they provide limited postoperative analgesic benefit compared with postoperative administration Calcium channel antagonists (Grade B) based on limited procedure-specific evidence showing a lack of postoperative analgesic effect Spinal anaesthesia Spinal morphine (Grade D) because of the risk of side effects Spinal clonidine (Grade B) based on procedure-specific evidence showing limited analgesic effect and the risk of side effects Non-pharmacological therapy Pre-operative use of guided imagery (Grade D) because of limited procedure-specific evidence Laxatives for analgesia (Grade B) because limited procedure-specific evidence shows no analgesic benefit (but they may be used for reasons other than pain relief Pentoxifylline (Grade D) due to limited procedure-specific evidence of its analgesic effect LA for analgesia Bilateral TAP block (Grade D) because of limited procedure-specific evidence
Intra-operative not not recommended	Systemic analgesia IV clonidine (Grade D) because it associated with an increased risk of hypotension, sedation and bradycardia Calcium channel antagonists (Grade B), based on limited procedure-specific evidence showing a lack of postoperative analgesic effect Gabapentin/pregabalin (Grade D) due to a lack of procedure-specific evidence Continuous administration of IV lidocaine limited to the pre-/intra-operative period (Grade D) because of inconsistent and insufficient procedure-specific evidence NMDA receptor antagonists (Grade D) because of limited procedure-specific evidence of analgesic efficacy Strong opioids (Grade D), in patients receiving epidural analgesia Weak opioids (Grade D), as placebo-controlled evidence for their benefit in reducing postoperative pain is limited. In patients not receiving epidural analgesia, strong opioids, not weak opioids, are recommended Epidural analgesia Addition of clonidine to the combination of epidural LA + opioid (Grade D) because of side effects Spinal analgesia Spinal analgesia in combination with epidural anaesthesia (Grade B) based on a lack of benefit in reducing postoperative pain in colonic resection
Postoperative not recommended	Systemic analgesia Gabapentin/pregabalin (Grade D) due to a lack of procedure-specific evidence NMDA receptor antagonists (Grade D) because of limited procedure-specific evidence of analgesic efficacy IM strong opioids (Grade D) Weak opioids (for controlling high-intensity pain) (Grade B) Wound infiltration or infusion Continuous postoperative wound infusion with LA (Grade D) as procedure-specific evidence is limited and inconsistent Pre-closure wound infiltration with local anaesthetic (Grade D) due to lack of procedure-specific evidence and inconclusive transferable evidence from other large abdominal surgeries Multi-modal rehabilitation protocols Mechanical massage with aspiration of abdominal wall (Grade D) as further supportive data are needed Nasogastric tubes (Grade A) because they are associated with discomfort and inconvenience and do not decrease the duration of postoperative ileus
Laparoscopic colonic resection not recommended	Systemic analgesia Continuous intra-/postoperative IV lidocaine (Grade D) because of limited procedure-specific data, despite some postive transferable evidence Spinal analgesia Combination of spinal analgesia and general anaesthesia (Grade D) as the risk: benefit balance is not positive, and because of limited procedure-specific evidence Epidural analgesia Epidural LA + strong opioid (Grade D) due to poor risk:benefit ratio Gasless laparoscopic colectomy Gasless laparoscopy (Grade B) based on procedure-specific evidence showing lack of analgesic effect Laxatives Laxatives for analgesia (Grade B) because limited procedure-specific evidence shows no analgesic benefit (but they may be used for reasons other than pain relief) Multi-modal rehabilitation protocols Postoperative restriction of IV fluids (Grade B) due to procedure-specific evidence showing limited analgesic efficacy