Neuraxial anesthesia for abdominal surgery, beyond the pandemic: a feasibility pilot study of 70 patients in a suburban hospital

Abstract

The aim of this study is to establish the feasibility of awake laparotomy under neuraxial anesthesia (NA) in a suburban hospital. A retrospective analysis of the results of a consecutive series of 70 patients undergoing awake abdominal surgery under NA at the Department of Surgery of our Hospital from February 11th, 2020 to October 20th, 2021 was conducted. The series includes 43 cases of urgent surgical care (2020) and 27 cases of elective abdominal surgery on frail patients (2021). Seventeen procedures (24.3%) required sedation to better control patient discomfort. Only in 4/70 (5.7%) cases, conversion to general anesthesia (GA) was necessary. Conversion to GA was not related to American Society of Anesthesiology (ASA) score or operative time. Only one of the four cases requiring conversion to GA was admitted to the Intensive Care Unit (ICU) postoperatively. Fifteen patients (21.4%) required postoperative ICU support. A statistically non-significant association was observed between conversion to GA and postoperative ICU admission. The mortality rate was 8.5% (6 patients). Five out of six deaths occurred while in the ICU. All six were frail patients. None of these deaths was related to a complication of NA. Awake laparotomy under NA has confirmed its feasibility and safety in times of scarcity of resources and therapeutic restrictions, even in the most frail patients. We believe that this approach should be considered as an useful asset, especially for suburban hospitals.

Neuraxial Anesthesia for an Open Low Anterior Rectal Resection: Tip the Scales in Patient’s Favor

“…We argue that neuraxial techniques can be safely and effectively administered with meticulous planning in frail patients with multiple comorbidities proposed for abdominal surgery when it would be preferable to avoid GA after conducting a comprehensive risk-benefit assessment. Moreover adopting this approach may not only diminish admissions to the Intensive Care Unit, thereby conserving beds for acute and trauma patients and reducing hospitalization costs during periods of resource scarcity and therapeutic constraints [ 8 ], but may also align with the Enhanced Recovery After Surgery (ERAS) concept, promoting rapid recovery and minimizing complications even in the context of open surgery. In our approach to CSE anesthesia, we did not use the "needle-through-needle" technique because failed dural puncture occasionally occurs [ 9 ] and because we consider it crucial to test peridural catheters before using them.…”

Emergency Awake Laparotomy Using Neuraxial Anaesthesia: A Case Series and Literature Review

“…No adverse respiratory events or hemodynamic instability was observed, and the patient was successfully discharged 12 days after surgery. Romanzi et al, [6] recently reported the feasible use of neuraxial anaesthesia in patients undergoing awake laparotomy. The authors included 43 patients requiring urgent abdominal surgery and 27 cases of elective abdominal surgery.…”

“…Awake laparotomies using neuraxial anaesthesia could be an innovative alternative to general anaesthesia for emergency abdominal surgery. In fact, even if abdominal surgeries have been traditionally performed under general anaesthesia, neuraxial anaesthesia has been reported as a possible feasible solution to manage high risk patients during emergency surgery [6]. This technique was employed during the COVID-19 pandemic to help prevent aerosolizing the virus during induction of general anaesthesia and the results demonstrated reduced complications and enhanced recovery [7,8].…”