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

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.

Keywords

• Upper abdominal surgery
• thoracic epidural anesthesia
• hemodynamics

References

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