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Evidence-based Practice and Quality Improvement

Effect of thoracic epidural analgesia on the perioperative period in patients undergoing colonic and rectal cancer surgery: a retrospective analysis

1AP3-3

Levit, D.; Podgorbunskikh, A.; Levit, A.

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European Journal of Anaesthesiology (EJA): June 2013 - Volume 30 - Issue - p 12-12
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Background and Goal of Study: Thoracic epidural analgesia (TEA) is commonly used intraoperatively and for the management of postoperative pain. The afferent neural blockade induced by epidural analgesia can decrease intra- and postoperative neuroendocrine stress responses. TEA can protect patients from the postoperative development of infectious complications. Aim of study - to evaluate the influence of the modes of anesthesia on perioperative period in patients undergoing colonic and rectal cancer surgery.

Materials and Methods: 610 patients were underwent colorectal surgery between January 2008 and December 2010. The following exclusion criteria were used: emergency operations, stage 4 cancer and laparoscopic-assisted technique. Patients were divided into two groups by the mode of anesthesia. Group 1(n=325) — thoracic epidural analgesia (TEA) + general anesthesia. Group 2 (n=285) — general anesthesia (GA). Date were processed using the AtteStat 12.5 software. Mann-Whitney test, Fisher's exact test and X2 test were calculated.

Results and Discussion: Patients in both groups were similar in gender, age (62.82±11.01 vs.64.27±10.11), ASA score (1.95±0.63 vs. 1.97±0.56), duration of the surgery (143.49±43.09 vs. 145.64±49.27 min.). Essential hypertension was in 62% patients in Group 1 and in 55% in Group 2, ischemic heart disease in 22 and 18% respectively. In both groups the diabetes mellitus and COPD patients accounted 7 and 8%, respectively.

The use of TEA during and after surgery did not require more fluids than the combined general anesthesia and opioid analgesia in the postoperative period. LOS in the ICU did not differ between groups. However, LOS in the hospital was significantly lower in Group 1 (10.63±2.64 vs. 11.48±4.27 days, p=0.05).

There were no significant differences in the complications between groups 33 (10.2%) and 41 (14.4%).Complications associated with operation area were happened in 20 patients group 1 and 30 patients group 2. In Group 1 patients we did not observe cardiac arrhythmia and decompensation of diabetes mellitus. 92% of complications were developed at the second day after surgery and later. Mortality was 1.84 and 1.75% (p>0.05) in Group 1 and Group 2, respectively.

Conclusion(s): Using TEA in the perioperative period reduces the hospital LOS in patients undergoing colonic and rectal cancer surgery, but does not reduce the number of complications.

© 2013 European Society of Anaesthesiology