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.