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Comparison of the Effects of Thoracic Epidural Analgesia in Different Levels on Intraoperative Hemodynamics in Abdominal Surgery: A Prospective Randomized Trial

Year 2024, Volume: 5 Issue: 2, 42 - 52, 30.05.2024
https://doi.org/10.56766/ntms.1333910

Abstract

Objective
Our aim was to investigate the effect of thoracic epidural anesthesia (TEA) at different levels on hemodynamic parameters in elderly patients undergoing upper abdominal surgery.
Materials and Methods
This randomized study was conducted on 60 patients aged 65 or above undergoing upper abdominal surgery. The patients were randomized into T6-7 and T9-10 groups, with epidural catheters placed at respective intervertebral spaces. Heart rate , systolic and diastolic blood pressure , mean arterial pressure , were recorded every 5 minutes for 30 minutes after TEA and every 10 minutes intraoperatively. Confirming adequate analgesia and 30 minutes after placement of a thoracic epidural catheter, general anesthesia was induced. Postoperative respiratory function tests, time to ambulation, gastrointestinal motility and length of stay were assessed.
Results
Group T6-7 and T9-10 differed for SBP at minutes 5,80, and 90 (p=0.003, p=0.007, p=0.013 respectively). At the same minutes, DBP (p<0.001) and MAP (p=0.009, p<0.001and p<0.001, respectively) significantly differed between groups. A difference was observed for heart rate at minutes 10, 60, 80, and 90 (p<0.001, p=0.005, p=0.003 and p<0.001, respectively). Groups were different for highest and lowest dermatome with block, return of gastrointestinal motility, and length of stay. (p=0.003, p=0.023, p=0.003, p=0.009, respectively)
Conclusion
Higher TEA was beneficial as it allowed better hemodynamics, respiratory functions, gastrointestinal motility and shorter length of stay compared to lower TEA.

Supporting Institution

none

References

  • 1. Wahba SS, Kamal SM. Analgesic efficacy and outcome of transversus-abdominis plane block versus low thoracic-epidural analgesia after laparotomy in ischemic heart disease patients. J Anesth. 2014; 28:517-23.
  • 2. Wu Y, Liu F, Tang H, et al. The analgesic efficacy of subcostal transversus abdominis plane block compared with thoracic epidural analgesia and intravenous opioid analgesia after radical gastrectomy. Anesth Analg. 2013; 117(2):507-13.
  • 3. Block Compared with Thoracic Epidural Analgesia and Intravenous Opioid Analgesia After Radical Gastrectomy. Anesth Analg. 2013; 117:507-13.
  • 4. Holman SJ, Bosco RR, Kao TC, Mazzilli MA. What Constitutes an Effective but Safe Initial Dose of Lidocaine to Test a Thoracic Epidural Catheter? Anesth Analg. 2001; 93:749-54.
  • 5. Veering BT, Cousins MJ. Cardiovascular and pulmonary effects of epidural anaesthesia. Anaesth Intensive Care 2000; 28:620-35.
  • 6. Wink J, Wolterbeek R, Aarts LP, Koster SC, Versteegh MI, Veering BT. Upper thoracic epidural anaesthesia: effects of age on neural blockade and cardiovascular parameters. Acta anaesthesiol Scand. 2013; 57:767-75.
  • 7. Jakobsen CJ, Bhavsar R, Nielsen DV, Ryhammer PK, Sloth E, Greisen J. High thoracic epidural analgesia in cardiac surgery. Part 1--high thoracic epidural analgesia improves cardiac performance in cardiac surgery patients. J Cardiothorac Vasc Anesth. 2012; 26:1039-47.
  • 8. Missant C, Claus P, Rex S, Wouters PF. Differential effects of lumbar and thoracic epidural anaesthesia on the haemodynamic response to acute right ventricular pressure overload. Br J Anaesth. 2010; 104:143-49.
  • 9. Gurses E, Berk D, Sungurtekin H, Mete A, Serin S. Effects of high thoracic epidural anesthesia on mixed venous oxygen saturation in coronary artery bypass grafting surgery. Med sci monit. 2013; 19:222-29.
  • 10. Veering BT. Cardiovascular and pulmonary effects of epidural anaesthesia. Minerva anestesiologica. 2003; 69:433-37.
  • 11. Manikian B, Cantineau JP, Bertrand M, Kieffer E, Sartene R, Viars P. Improvement of diaphragmatic function by a thoracic extradural block after upper abdominal surgery. Anesthesiology. 1988; 68:379-86.
  • 12. Groeben H. Epidural anesthesia and pulmonary function. J Anesth. 2006; 20:290-9.
  • 13. Sundberg A, Wattwil M, Arvill A. Respiratory effects of high thoracic epidural anaesthesia. Acta anaesthesiol Scand. 1986; 30:215-17.
  • 14. Takasaki M, Takahashi T. Respiratory function during cervical and thoracic extradural analgesia in patients with normal lungs. Br J Anaesth. 1980; 52:1271-76.
  • 15. Clemente A, Carli F. The physiological effects of thoracic epidural anesthesia and analgesia on the cardiovascular, respiratory and gastrointestinal systems. Minerva anestesiol. 2008; 74:549-63.
  • 16. Lee J, Shim JY, Choi JH, Kim ES, Kwon OK, Moon DE, et al. Epidural naloxone reduces intestinal hypomotility but not analgesia of epidural morphine. C J Anaest. 2001; 48:54-58.
  • 17. Zugel N, Bruer C, Breitschaft K, Angster R. [Effect of thoracic epidural analgesia on the early postoperative phase after interventions on the gastrointestinal tract]. Chirurg. 2002; 73:262-68.
Year 2024, Volume: 5 Issue: 2, 42 - 52, 30.05.2024
https://doi.org/10.56766/ntms.1333910

Abstract

References

  • 1. Wahba SS, Kamal SM. Analgesic efficacy and outcome of transversus-abdominis plane block versus low thoracic-epidural analgesia after laparotomy in ischemic heart disease patients. J Anesth. 2014; 28:517-23.
  • 2. Wu Y, Liu F, Tang H, et al. The analgesic efficacy of subcostal transversus abdominis plane block compared with thoracic epidural analgesia and intravenous opioid analgesia after radical gastrectomy. Anesth Analg. 2013; 117(2):507-13.
  • 3. Block Compared with Thoracic Epidural Analgesia and Intravenous Opioid Analgesia After Radical Gastrectomy. Anesth Analg. 2013; 117:507-13.
  • 4. Holman SJ, Bosco RR, Kao TC, Mazzilli MA. What Constitutes an Effective but Safe Initial Dose of Lidocaine to Test a Thoracic Epidural Catheter? Anesth Analg. 2001; 93:749-54.
  • 5. Veering BT, Cousins MJ. Cardiovascular and pulmonary effects of epidural anaesthesia. Anaesth Intensive Care 2000; 28:620-35.
  • 6. Wink J, Wolterbeek R, Aarts LP, Koster SC, Versteegh MI, Veering BT. Upper thoracic epidural anaesthesia: effects of age on neural blockade and cardiovascular parameters. Acta anaesthesiol Scand. 2013; 57:767-75.
  • 7. Jakobsen CJ, Bhavsar R, Nielsen DV, Ryhammer PK, Sloth E, Greisen J. High thoracic epidural analgesia in cardiac surgery. Part 1--high thoracic epidural analgesia improves cardiac performance in cardiac surgery patients. J Cardiothorac Vasc Anesth. 2012; 26:1039-47.
  • 8. Missant C, Claus P, Rex S, Wouters PF. Differential effects of lumbar and thoracic epidural anaesthesia on the haemodynamic response to acute right ventricular pressure overload. Br J Anaesth. 2010; 104:143-49.
  • 9. Gurses E, Berk D, Sungurtekin H, Mete A, Serin S. Effects of high thoracic epidural anesthesia on mixed venous oxygen saturation in coronary artery bypass grafting surgery. Med sci monit. 2013; 19:222-29.
  • 10. Veering BT. Cardiovascular and pulmonary effects of epidural anaesthesia. Minerva anestesiologica. 2003; 69:433-37.
  • 11. Manikian B, Cantineau JP, Bertrand M, Kieffer E, Sartene R, Viars P. Improvement of diaphragmatic function by a thoracic extradural block after upper abdominal surgery. Anesthesiology. 1988; 68:379-86.
  • 12. Groeben H. Epidural anesthesia and pulmonary function. J Anesth. 2006; 20:290-9.
  • 13. Sundberg A, Wattwil M, Arvill A. Respiratory effects of high thoracic epidural anaesthesia. Acta anaesthesiol Scand. 1986; 30:215-17.
  • 14. Takasaki M, Takahashi T. Respiratory function during cervical and thoracic extradural analgesia in patients with normal lungs. Br J Anaesth. 1980; 52:1271-76.
  • 15. Clemente A, Carli F. The physiological effects of thoracic epidural anesthesia and analgesia on the cardiovascular, respiratory and gastrointestinal systems. Minerva anestesiol. 2008; 74:549-63.
  • 16. Lee J, Shim JY, Choi JH, Kim ES, Kwon OK, Moon DE, et al. Epidural naloxone reduces intestinal hypomotility but not analgesia of epidural morphine. C J Anaest. 2001; 48:54-58.
  • 17. Zugel N, Bruer C, Breitschaft K, Angster R. [Effect of thoracic epidural analgesia on the early postoperative phase after interventions on the gastrointestinal tract]. Chirurg. 2002; 73:262-68.
There are 17 citations in total.

Details

Primary Language English
Subjects Anaesthesiology
Journal Section Research Articles
Authors

Ahmet Kacıroğlu 0000-0001-8911-2225

Aysenur Dostbıl 0000-0002-7167-901X

İlker İnce1 0000-0003-1791-9884

Mehmet Aksoy 0000-0003-0867-8660

Suna Mehtap Celik 0000-0002-5675-0121

Publication Date May 30, 2024
Submission Date July 28, 2023
Published in Issue Year 2024 Volume: 5 Issue: 2

Cite

EndNote Kacıroğlu A, Dostbıl A, İnce1 İ, Aksoy M, Celik SM (May 1, 2024) Comparison of the Effects of Thoracic Epidural Analgesia in Different Levels on Intraoperative Hemodynamics in Abdominal Surgery: A Prospective Randomized Trial. New Trends in Medicine Sciences 5 2 42–52.