The Effect of Regional Anesthesia on Outcomes After Minimally Invasive Ivor Lewis Esophagectomy

Minimally Invasive Esophagectomy In the Modern Era: Is Regional Anesthesia Still the Answer?

“…11,23,24 Tankard et al addressed mortality as a primary outcome as it relates to the use of regional anesthetic techniques and found no differences. 14 Likewise, secondary outcomes metrics, including failure to wean from mechanical ventilation and reintubation, demonstrated repeatedly to be improved with TEA in open procedures, were no different between groups. A limitation of their study was, with the exception of epidural anesthesia, failure of the NSQIP dataset to differentiate among the various types of regional blocks, such that paravertebral blocks were combined with chest wall and other types of regional techniques in the analysis.…”

“…In the current issue of the Journal of Cardiothoracic and Vascular Anesthesia, Tankard et al have presented data on the impact of regional anesthesia (all types included in the analysis) on outcomes after minimally invasive Ivor Lewis esophagectomy (MIE). 14 Using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), the authors compared 398 patients from multiple institutions who underwent MIE under general anesthesia with (n = 108) or without (n = 290) regional anesthesia. Multivariate regression was used to study the primary outcome of 30-day mortality, and secondary outcomes that included operative reexploration, failure to wean from mechanical ventilation, reintubation, and hospital length of stay, among others.…”

“…The retrospective nature of the study by Tankard et al, and the extraction of NSQIP data from multiple institutions, did raise questions about individual practices, including choice of anesthetic modality, and care pathways that are not likely to be uniform across institutions, as noted by the authors. 14 Furthermore, because the study included all forms of esophageal disease, not just malignancy, perioperative care was likely heterogenous from the standpoint of adjuvant therapies.…”

“…The study by Tankard et al perhaps raised more questions than it answers, but such is the nature of scientific inquiry. 14 The benefits of TEA and paravertebral blocks will continue to be challenged as anesthesiologists integrate more techniques into the armamentarium. Ultrasound-guided fascial plane blocks have become increasingly popular in both thoracic and abdominal surgery.…”

“…Do the findings from Tankard et al's study mean that anesthesiologists should relegate epidural and regional techniques only to traditional open thoracoabdominal approaches? 14 The answer to this question is a resounding no! The findings from this study are clearly relevant, but without greater context, anesthesiologists must be satisfied with the fact that they raised further questions worthy of future investigation, preferably in larger-scale randomized controlled trials.…”