Thoracic Epidural Anesthesia for Modified Radical Mastectomy - In Type2 Diabetes Mellitus Patient

Abstract

with Fentanyl 25ug, total of 8ml supplemented through the epidural catheter 12 hourly for 48 hours. Remaining part of postoperative stay was uneventful. She remained clinically stable and was discharged on the 6 th postoperative day. DISCUSSION:People with diabetes undergoing surgery have an almost 50% greater chance of postoperative mortality and morbidity than those with normal glucose tolerance. Mortality rates in diabetics following surgery are estimated to be 5 times greater than in non-diabetic counter parts; often due to end organ damage and infections.Thoracic epidural anesthesia (TEA) has been established as a cornerstone in perioperative care after thoracic and major abdominal surgery providing most effective analgesia. (8) It is possible to use single dose TEA for oncology mastectomies with axillary clearence, and this technique has many advantages when compared with general anesthesia. (4) TEA is associated with decreased incidence of nausea and vomiting and earlier discharge from the hospital compared to patients with general anesthesia. (9) Successful use of high TEA avoids problems of difficult tracheal intubation, stress of anesthesia and surgery and hemodynamic changes associated with tracheal intubation. Stress associated with anesthesia and surgery results in increased catecholamine levels, increased left ventricular afterload, heart rate, and cardiac complications. TEA has been shown to decrease adverse perioperative cardiac events, morbidity and mortality after cardiac and non-cardiac major surgery. (10,11) Autonomic neuropathy and macro vascular complications can lead to silent ischemia and myocardial infarction in long standing DM usually on the 2 nd or 3 rd post-operative day usually in the night. A segmental temporary sympathetic block provided by TEA is assumed to be an important beneficial factor of perioperative effects of TEA. (12,13) As patient was a known case of long standing type 2 DM and hypertension, we planned the procedure under sole anesthetic technique of TEA which provided safe and excellent surgical conditions. Patient tolerated the procedure well without any perioperative complications with additional benefit of prolonged postoperative analgesia. But TEA is also associated with complications hence one should always assess the risk and benefit ratio before planning the procedure. All the equipment and drugs should be kept ready to manage the complications and supplement general anesthesia if block fails or results in the inadequate block. Common complication of the technique is dural puncture, neurological injury and epidural hematoma9 (14) . With maximum precautions in experienced hand dural puncture is rare and incidence of neurological injury is 0.01-0.001%. (15) CONCLUSION: In conclusion, thoracic epidural anesthesia can be a better option to general anesthesia for modified radical mastectomy in high risk patients with long standing DM with co morbidities. Among the benefits of the technique includes a good postoperative analgesia, lower incidence of post-operative nau...

A Comparative Study between Thoracic Epidural Anesthesia and General Anesthesia for Patients Who Underwent Modified Radical Mastectomy with Axillary Lymph Node Dissection in De La Salle University Medical Center

“…(1) Regional block has a lower incidence of nausea and vomiting, when compared to general anesthesia, which has been demonstrated in several procedures and studies. (1)(2)(3)(4)(5)(6) But in this study, the incidence of this complication was statistically not signiicant. This might due to the opioids that were used for postoperative pain control in both groups (intravenous oxycodone/tramadol in GETA group and epidural morphine in CTEA group).…”

“…Clinical evidences suggest that epidural anesthesia has been associated with fewer postsurgical recovery complications and shorter hospital stays, but the adequacy of thoracic and axillary blockade during lymph node dissection is still a problem. (1)(2)(3)(4)(5) Although several research were done using Continuous Thoracic Epidural Anesthesia (CTEA) as alternative of General Endotracheal Tube Anesthesia (GETA) technique during Modiied Radical Mastectomy (MRM), they were all foreign studies. It is signiicant to know the clinical outcome among Filipino patients especially since there was no previous local study.…”

Non-intubated thoracic epidural anesthesia for modified radical mastectomy as an alternative to general anaesthesia

“…Hiremath made a study with a type 2 diabetes mellitus patient who had MRM under TEA. Patients tolerated the procedure well without any perioperative complications with additional benefit of prolonged postoperative analgesia 10 .…”