Dear David, 

this paper may not be to the point but check with the authors: 

Article Anesthésie péridurale et réponse métabolique à l'agression c...

Use of wound catheters (soak catheters) enable opiate reduction/avoidance.

i can provide more detail if requested

I think preoperative opiate and fentanyle can be given and post operative perfalgan and  NSAID like ketolac can be given.

Thank you for the answer. Very interesting. In the laparoscopy surgery if the incision for remove the large intestine is infraumbilical I use tranversus abdominal plane block  and if the incision is supraumbilical i use sheath rectum block. In the case of open surgery I use epidural block. Intraoperative continous lidocaine 1-1,5 mg/kg/h is used.  

We are just preparing a study comparing thoracic epidural (low-dose bupivacaine+ sufentanil) vs. single shot preservative-free spina morphine 250 mcg) + regular paracetamol/metamizol + ketoprofen + SOS PCA morphine.

 I prefer to use transversus abdominal plane block  with bupivacaine 0.25% with buprigesic 150 mcg  or epidural Bolus of 150mcg of epidural buprigesic during GA with bupivacaine 0.125% + fent.2mcg/ml as infusion for postoperative analgesia  ;

Prescribe Tramadol 50 -100mcg on sos basis postoperatively for breakthrough pain.

Epidural analgesia  to reduce the dose of general anesthetic needed and the stress response to surgery. In order to reduce the release of stress hormones and post-operative insuline resistance it is very important start with the epidural analgesia before the surgery . after surgery we give low dose narcotics in combination with epidural analgesia 

Epidural analgesia (EA) with local anaesthetic is considered to play a key role after colorectal surgery. However, its effect on postoperative recovery is still a matter of debate.

Since introducing of dexmedetomidine, I have stopped performing epidural anesthesia in combinitation with general anesthesia. Dex blocks sympathetic system, enhances opioids ability, with no respiratory effect. The point with Dex is to reach plasma level before incision, and to perform a balance anesthesia, with zero management, in order not to stimulate right heart with fluid overload,so you will not provoke edema in the area of anastomosis.

на операции эпидуральная и общая анестезия, в послеоперационном периоде-первые сутки-эпидуральный блок, далее трамал и кеторолак.

Analgesia is but one part of ERAS; there are good protocols available for the full package of care. Importantly, in the UK we found it took the longest to change the preconceptions of nurses when introducing ERAS, as they are responsible for ensuring dietary and mobilisation targets are adhered to. Regarding analgesia, local blocks/infusions and epidurals have a great adjuvant effect; the data on NSAIDS is poor quality. We are all aware of renal side effects, the data on leaks is not practice-changing. Read the Cochrane meta-analysis before removing paracetamol and NSAIDs with a PPI from your armatarium. The data on Ketamine infusions is telling as well - it does not enhance analgesic effects; it helps in patients with opioid hypersensitivity, but does nothing to reduce the detrimental effects of these drugs. Finally, to ensure a programme is introduced, keep it simple and include your patients actively;,they have the most to gain after all! 

i am agrree with you

Marina: you can correct this translation:

operation with epidural and general anesthesia, postoperative first-day-epidural block, then Tramal and ketorolac.

An other possibility is continuous i.v. lidocaine.

I think intra operative epidural is good then postoperative epidural block and narcotics+NSAID