Introduction: Enhanced Recovery after Surgery (ERAS) protocols emphasizes multimodal interventions to accelerate recovery. This study evaluates the role of intrathecal analgesia with diamorphine in optimizing postoperative outcomes, focusing on pain control, length of stay(LOS), and complications

Methods: A retrospective cohort study was conducted on 246 patients undergoing elective robotic assisted colorectal surgeries between July 2021 and November 2024 at two hospitals in a single Trust (Hospitals A and B). Patients were grouped based on analgesia type: Intrathecal analgesia with Diammoprhine (IA) [Intervention] and non-intrathecal analgesia(nIA) [Control] groups. Primary outcomes included LOS, postoperative pain scores and opioid consumption. Secondary outcomes were post operative ileus(POI) and time to first bowel movement.

Results: Intrathecal Analgesia with Diamorphine was used in 61.8% and 0% of cases at Hospitals A and B respectively. Patients receiving IA in hospital A compared to nIA in Hospital A and B had significantly short LOS (5.3 days vs 6.1 days and 7.0 days, p<0.001), reduced opioid requirements (96.8% reduction, p<0.00001), and a lower incidence of POI (4.5% vs 13.2% and 14.7%, p=0.02). Time to bowel function recovery was also faster in IA group(2.6 days vs 3.0 days in other groups, p=0.03)

Conclusions: Intrathecal analgesia with diamorphine significantly enhances recovery in elective robotic assisted colorectal surgery

Mr Devadoss is currently a trainee registrar in East of England, Ipswich Hospital, with a growing focus on Colorectal Surgery. He completed his medical school in India and then moved to UK to pursue higher training. He has worked and trained in various parts of the country with experience as a junior doctor in multiple surgical specialties, gaining transferable skills from these specialties. During this time he was involved with various collaborative studies and invigorated his interest in medical education with a PG Cert. He is now beginning his colorectal training and aspires to contribute effectively to the future of surgery in UK. When not operating, you can find him drumming or playing table tennis.