Thoracal epidural analgesia in upper abdominal surgery

Introduction

Surgery of upper abdominal organs is painful and mutilating, joined with possible serious postoperative complications – pulmonary, abdominal (anastomoses related), cardiological, and thromboembolic.

Methods

During past year 100 patients had upper abdominal surgery. According to analgesia type they were divided into two groups. The first group (G1) was administered a first dose of local anesthetic (bupivacain 0.25% 5 ml) prior to total anesthesia through a thoracic epidural catheter. After that they underwent classical total anesthesia (midazolam, diprivan, fentanil, relaxant), followed by anesthesia with diprivan 6 mg/kg/hour and analgesia with local anesthetic epidurally. Postoperatively they were administered through the thoracic epidural catheter a combination of opioids (morphine 2 mg) and local anesthetic (bupivacain 0.125% 6–8 ml) every 8 hours. The other group (G2) underwent classical total anesthesia followed by classical proportion of oxidul and oxygen, and analgesia by fentanyl, with postoperative systemic analgesia by nonsteroid anti-inflammatory drugs, paracetamol, and metamisol sodium. The parameters followed during surgery were arterial tension, heart rate, gas analysis, diuresis, and operating field bleeding. The postoperatively followed parameters were Visual Analog Scale, arterial tension, heart rate, gas analysis, beginning of peristalsis, and pulmonary complications.

Results

Thoracic epidural analgesia during surgery provides better hemodynamic patient stability and lower blood loss due to intraoperative bleeding, statistically and clinically significantly better analgesia in the first postoperative 72 hours, compared with systemic analgesia (Visual Analog Scale, G1 < 8 in movement vs G2 > 30 in movement), reduces the period of postoperative ileus (for 1.06 days), reduces pulmonary and cardiologic complications, provides early patient mobilization and decreases the number of intensive postoperative care days (for 3.9 days).

Conclusion

Our experience shows that thoracic epidural analgesia is the right choice, because it provides effective pain relief in patients, prevention of postoperative complications, provides early patient mobilization and reduces the length of stay in the ICU.