Prolonged perioperative thoracic epidural analgesia may improve survival after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: A comparative study

Guidelines for Perioperative Care in Cytoreductive Surgery (CRS) with or without hyperthermic IntraPEritoneal chemotherapy (HIPEC): Enhanced Recovery After Surgery (ERAS®) Society Recommendations — Part II: Postoperative management and special considerations

“…Epidural block should include segments T5-T11 47 and the infusion should start early during surgery [46]. A single centre retrospective analysis reported an improved survival after HIPEC when TEA was used compared to patient-controlled opioid analgesia opioids [48]. Similar results were found in CRS for epithelial ovarian cancer if TEA was used for more than 48 h postoperatively [49].…”

Guidelines for Perioperative Care in Cytoreductive Surgery (CRS) with or without hyperthermic IntraPEritoneal chemotherapy (HIPEC): Enhanced recovery after surgery (ERAS®) Society Recommendations — Part I: Preoperative and intraoperative management

“…Epidural anaesthesia has the potential to provide excellent pain relief for large laparotomies [141,142] and reduce pulmonary complications [143]. Prolonged thoracic epidural analgesia (over 72 h) is currently of interest as it may contribute to both an improved disease-free survival and overall survival [144] This patient group presents a wide range of specific physiologic challenges within the respiratory, cardiac, renal and coagulation systems. Abdominal distension from ascites will decrease the functional residual capacity of the lungs, thus increasing the likelihood of arterial oxygen desaturation with an increased PaO 2 /FiO 2 ratio as well as an increased PaCO 2 .…”

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

“…Some studies have recommended the use of TEA to reduce the incidence of postoperative intestinal obstruction [79,80]. Regional anesthesia also improves tumor recurrence and postoperative survival rates [81][82][83][84][85]. This might also reduce the incidence of chronic pain and improve patient satisfaction [86].…”