Effects of Thoracic Epidural Analgesia in Thoracic and Upper Abdominal Surgery on Perioperative Stress and Morbidity
Abstract
Background:
Thoracotomies and laparotomies are surgical procedures prescribed for the management of
multiple ailments resulting from trauma, malignancy, congenital, acquired defects and source
control in sepsis. Despite multiple gains from safe anaesthesia administration, sympathetic arousal
that is associated with surgery results in multiple physiological changes that may be harmful to
patients. Thoracotomies are widely known as one of the surgical interventions with excruciating
pain. There are attempts to minimize these unwanted effects of surgery by safe anesthesia
administration and multimodal pain management. Studies have demonstrated epidural analgesia
to be a superior form of pain management compared to conventional modes of analgesia. However,
we had no local data and information on the effects of these modes of analgesia on patient
outcomes following major abdominal and thoracic surgery.
Methodology:
An observational cohort study was performed at The Kenyatta National Hospital and The Coptic
Hospital Nairobi. Eligible patients undergoing thoracic and upper abdominal surgeries under
general anaesthesia were recruited into the study by consecutive sampling. Preoperative fasting
blood sugar and vitals were determined. Thoracic epidural catheter was inserted, and general
anaesthesia administered as per physician’s protocol. Intraoperative physiologic vital parameters
were recorded as per protocol. Postoperative fasting blood sugar, haematological profile, pain
scores and need for rescue analgesia were recorded and compared among participants undergoing
epidural and conventional anaesthesia.
Results:
The study involved 127 eligible and consented patients. 32 patients had thoracic epidural analgesia
while 95 patients received conventional modes of analgesia. The patients were well matched in
terms of age, gender and clinical comorbidities. The patients across all groups had the same
hemodynamic profile with no alterations observed based on mode of analgesia. The patients under
thoracic epidural analgesia showed better postoperative pain control compared to those who
received multimodal conventional analgesics. Alterations in postoperative white blood cell count
2
and fasting blood sugars were seen across all groups with significant changes observed in patients
who received thoracic epidural analgesia.
Conclusion:
Thoracic epidural analgesia confers better perioperative pain control in patients under thoracic and
abdominal surgery. Multimodal conventional analgesics and thoracic epidural analgesia confer
same and adequate intraoperative hemodynamic profiles.
Publisher
university of nairobi
Rights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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