Background and objectivesMajor abdominal cancer surgeries are associated with significant perioperative mortality and morbidity due to myocardial ischemia and infarction. This study examined the effect of perioperative patient controlled epidural analgesia (PCEA) on occurrence of ischemic cardiac injury in ischemic patients undergoing major abdominal cancer surgery.Patients and methodsOne hundred and twenty patients (American Society of Anesthesiologists grade II and III) of either sex were scheduled for elective upper gastrointestinal cancer surgeries. Patients were allocated randomly into two groups (60 patients each) to receive, besides general anesthesia: continuous intra and postoperative intravenous (IV) infusion with fentanyl for 72 h postoperatively (patient controlled intravenous analgesia [PCIA] group) or continuous intra and postoperative epidural infusion with bupivacaine 0.125% and fentanyl (PCEA group) for 72 h postoperatively. Perioperative hemodynamics were recorded. Postoperative pain was assessed over 72 h using visual analog scale (VAS). All patients were screened for occurrence of myocardial injury (MI) by electrocardiography, echocardiography, and cardiac troponin I serum level. Other postoperative complications as arrhythmia, deep venous thrombosis (DVT), pulmonary embolism, pneumonia, and death were recorded.ResultsThere was a significant reduction in overall adverse cardiac events (myocardial injury, arrhythmias, angina, heart failure and nonfatal cardiac arrest) in PCEA group in comparison to PCIA group. Also, there was a significant reduction in dynamic VAS pain score in group PCEA in comparison to PCIA at all measured time points. Regarding perioperative hemodynamics, there was a significant reduction in intra-operative mean arterial pressure (MAP); and heart rate in PCEA group in comparison to PCIA group at most of measured time points while there was not a significant reduction in postoperative MAP and heart rate in the second and third postoperative days. The incidence of other postoperative complications such as DVT, pneumonia and in hospital mortality were decreased in PCEA group.ConclusionPerioperative thoracic epidural analgesia in patients suffering from coronary artery disease subjected to major abdominal cancer surgery reduced significantly postoperative major adverse cardiac events with better pain control in comparison with perioperative IV analgesia.

Background and Objectives: Major gastrointestinal cancer surgeries are associated with significant perioperative mortality and morbidity due to increased incidence of major perioperative cardiovascular event (MACEs). This study examined the effect of perioperative patient controlled epidural analgesia (PCEA) on reduction of MACEs in cardiac risky patients undergoing major gastrointestinal cancer surgery.Methods: 60 patients (ASA II and III) of either sex were scheduled for elective Upper gastrointestinal cancer surgeries. Patients were allocated randomly into two groups (30 patients each) to receive, beside GA: continuous intra and post -operative intravenous infusion with fentanyl for 72 hours post-operatively (control group) or continuous intra and post -operative epidural infusion with bupivacaine 0.125% and fentanyl (TEA group) for 72 hours post-operatively Intra-operative and post operative (HR and MAP) were recorded. Postoperative pain was assessed over 72 h using numerical rating scale (NRS). All patients were screened for occurrence of MACEs by ECG and echocardiography. And other postoperative complications and duration of ICU stay were recorded.Results: There was a significant decrease in the incidence of MACEs with less pain scores in patients of TEA group in comparison to control group. Postoperative complications were comparable in both groups. Conclusion:Perioperative PCEA in cardiac risky patients subjected to major gastrointestinal cancer surgery reduced significantly postoperative major adverse cardiac events with better pain control in comparison with perioperative PCIA analgesia.