Lack of significant intraoperative coagulopathy in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) indicates that epidural anaesthesia is a safe option

Korakianitis, Odysseus; Daskalou, Telemachos; Alevizos, Leonidas; Stamou, Konstantinos M.; Mavroudis, Christos; Iatrou, Christos; Vogiatzaki, Theodosia; Eleftheriadis, S.; Tentes, Antonios Apostolos

doi:10.3109/02656736.2015.1075606

Cited by 20 publications

(29 citation statements)

References 35 publications

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“…Additionally, the procedure has been depicted as a high risk with significant levels of comorbidity (22–39%), mortality (5%) and prolonged hospital stays [ 11 ]. Although cytoreductive surgery (CRS) and hyperthermic intraperitoneal preoperative chemotherapy (HIPEC) have established its therapeutic role in selected patient populations with peritoneal carcinomatosis (PC), multiple factors can disrupt the patient metabolism during and after surgery [ 12 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

Thrombin generation and platelet activation in cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy - A prospective cohort study

et al. 2018

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Background and objectivesCytoreductive surgery (CRS) with hyperthermic intraperitoneal peroperative chemotherapy (HIPEC), indicated for patients with peritoneal metastases from digestive or gynecological malignancies alike, demonstrates a considerable impact on hemostatic metabolism, both on platelet and on coagulation level. The potential hemostatic interference in CRS and HIPEC is phase dependent. The hypothesis of this prospective cohort study is that the procedure exposed an increased thrombotic risk, resulting in a faster and increased thrombin generation and hyper platelet function.MethodsThis study explores the combined use of ROTEM (rotational thromboelastometry), PACT (platelet activation test) and CAT (thrombin generation test) assays during CRS and HIPEC with a follow-up of 7 days postoperative in 27 patients with confirmed histological diagnosis of peritoneal disease.ResultsPlatelet reactivity (relative to before incision values) to CRP (collagen-related peptide) (p value 0.02) and TRAP (thrombin receptor activator peptide) (p value 0.048) seems to be slightly reduced during CRS and HIPEC with regard to αIIbβ3 activation, while P-selectin expression is not affected. During surgery, CAT demonstrates that, the LT (lagtime) (p value 0.0003) and TTP (time-to-thrombin peak) values (p value 0.002) decrease while and the TP (thrombin peak) (p value 0.004) and ETP (endogenous thrombin potential) (p value 0.02) increase. Subsequently, after surgery, the LT and TTP increase and ETP and TP decrease in time. ROTEM EXTEM (extrinsic) MCF (maximum clot firmness) (p value 0.005), INTEM (intrinsic) MCF (p value 0.003) and FIBTEM (fibrinogen) MCF (p value <0.001) decreased during CRS. At day 7 INTEM and FIBTEM MCF values (p values of 0.004 and <0.001) were significantly higher than before surgery. No considerable changes in platelet count and hemoglobin concentration and absence of leukopenia are noticed.ConclusionThis approach detects changes in coagulation much earlier than noticed by standard coagulation tests.

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Section: Introductionmentioning

confidence: 99%

Thrombin generation and platelet activation in cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy - A prospective cohort study

et al. 2018

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“…However, epidural analgesia should be used with caution in patients with CRS and HIPEC. Although not many cases are reported of coagulation abnormalities that are insufficient to maintain and remove the epidural catheter after surgery [ 17 ], but massive bleeding may occur during the surgery, according to the severity or invasiveness of the cancer. Hurdle et al [ 18 ] reported that postoperative coagulopathy occurred in approximately 40% of patients who underwent CRS with HIPEC, and the incidence was higher with intraoperative blood transfusion or higher PCI scores.…”

Section: Discussionmentioning

confidence: 99%

Analgesic effects of ultrasound-guided four-quadrant transabdominal plane block in patients with cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a prospective, randomized, controlled study

et al. 2022

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Background: Postoperative pain occurring after cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is difficult to control because of extensive surgical injuries and long incisions. We assessed whether the addition of a four-quadrant transabdominal plane (4Q-TAP) block could help in analgesic control.Methods: Seventy-two patients scheduled to undergo elective CRS with HIPEC and intravenous patient-controlled analgesia (IV PCA) were enrolled. The patients received 4Q-TAP blocks in a 10 ml mixture of 2% lidocaine and 0.75% ropivacaine per site (4Q-TAP group, n = 36) or normal saline (control group, n = 33). Oxycodone in the post-anesthesia care unit (PACU) and pethidine or tramadol in the ward were used as rescue analgesics. The primary outcome was less than 3 times of rescue analgesic administration (%) in the ward for 5 postoperative days. Secondary endpoints included oxycodone requirement in PACU, fentanyl doses of IV PCA, morphine milligram equivalent (MME) of total opioid use, hospital stay, and postoperative complications. Results: During 5 postoperative days, there was no difference in pain scores and total rescue analgesic administration between two groups. However, the use of oxycodone in PACU (P = 0.011), fentanyl requirement in IV PCA (P = 0.029), and MME/kg of total opioid use (median, 2.35 vs. 3.21 mg/kg, P = 0.009) were significantly smaller in the 4Q-TAP group. Hospital stay and incidence of postoperative morbidity were similar in both groups. Conclusions: The 4Q-TAP block enhanced multimodal analgesia and decreased opioid requirements in patients with CRS with HIPEC, but did not change postoperative recovery outcomes.

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“…TEA combined with opioids has the advantages of analgesia, early extubation after surgery, lower postoperative pulmonary complications, and reduced incidence of postoperative complications [67][68][69][70] TEA is a safe option for CRS + HIPEC treatment, regardless of some fluctuations in intraoperative coagulation measurements [71,72]. [62].…”

Section: Regional Nerve Blockmentioning

confidence: 99%

“…However, there are controversies in the implementation of TEA, since HIPCE could affect blood coagulation and cause thrombocytopenia [68]. A recent prospective clinical study indicated that TEA is a safe option for CRS + HIPEC treatment, regardless of some fluctuations in intraoperative coagulation measurements [71]. Chua et al investigated 4277 patients who received the CRS + HIPEC treatment and found no postoperative epidural hematoma in these patients [72].…”

Section: Regional Nerve Blockmentioning

confidence: 99%

Postoperative pain pathophysiology and treatment strategies after CRS + HIPEC for peritoneal cancer

Wang

2020

World J Surg Onc

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Background: Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment choice for peritoneal cancer. However, patients commonly suffer from severe postoperative pain. The pathophysiology of postoperative pain is considered to be from both nociceptive and neuropathic origins. Main body: The recent advances on the etiology of postoperative pain after CRS + HIPEC treatment were described, and the treatment strategy and outcomes were summarized. Conclusion: Conventional analgesics could provide short-term symptomatic relief. Thoracic epidural analgesia combined with opioids administration could be an effective treatment choice. In addition, a transversus abdominis plane block could also be an alternative option, although further studies should be performed.

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Lack of significant intraoperative coagulopathy in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) indicates that epidural anaesthesia is a safe option

Cited by 20 publications

References 35 publications

Thrombin generation and platelet activation in cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy - A prospective cohort study

Thrombin generation and platelet activation in cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy - A prospective cohort study

Analgesic effects of ultrasound-guided four-quadrant transabdominal plane block in patients with cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a prospective, randomized, controlled study

Postoperative pain pathophysiology and treatment strategies after CRS + HIPEC for peritoneal cancer

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