Thoracic epidural analgesia reduces myocardial injury in ischemic patients undergoing major abdominal cancer surgery

Abstract

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.

Combined epidural-general anesthesia was associated with lower risk of postoperative complications in patients undergoing open abdominal surgery for pheochromocytoma: A retrospective cohort study

“…A meta-analysis also showed that use of epidural analgesia reduced pulmonary complications after abdominal and thoracic surgery, probably due to earlier mobilization, reduced opioid consumption, and improved cough [ 20 ]. In a recent study, use of perioperative thoracic epidural analgesia reduced the occurrence of major adverse cardiac events (including deep venous thromboembolism) after major abdominal cancer surgery in patients suffering from coronary artery disease [ 21 ]. For the first time, our results showed that combined use of epidural anesthesia/analgesia was associated with decreased risk of postoperative complications in patients undergoing open abdominal surgery for pheochromocytoma.…”

Effects of long periods of pneumoperitoneum combined with the head-up position on heart rate-corrected QT interval during robotic gastrectomy: an observational study

“…With regard to the type of surgery, thoracic and upper abdominal surgeries appear to be associated with a higher risk of arrhythmia than surgeries at other sites. 18 , 19 For a better surgical view and approach, robotic gastrectomy is usually performed under the head-up position. The head-up position might have been a contributing factor to the results of the present study.…”

Awareness of People towards first Aid management of Burns among under five Years Children at Buramba Cell One Bushenyi District.

“…Furthermore, the study findings above are in line witha study done by the [8] which found out that 77.4% of respondents knew of traditional home remedies and potentially used them during first aid management of burns [17][18][19][20][21][22] The study findings above are still consistent with a study done in Kwa-Zulu Natal by [17], which revealed that 59.2 % used substances like eggs, butter, and soap during first aid management of burns. This could be because community members lack of information about the negative effects resulting in use of traditional home remedies during the first aid management of burns in children under five years [23][24][25][26][27].…”