מתוך medicontext.co.il
WESTPORT, CT (Reuters Health) – Epidural anesthesia followed by epidural analgesia provides better pain relief than a general anesthesia/parental opioid regimen often used during major surgery, according to a report published in the October issue of the Annals of Surgery.
For patients undergoing abdominal aortic operations, the epidural regimen is also associated with an improvement in overall outcome and a shortening of intubation time and intensive care length of stay.
Dr. Jon S. Thompson, from the University of Nebraska Medical Center in Omaha, and colleagues studied 1021 patients who underwent major abdominal operations and were randomized to receive a general or epidural anesthesia/analgesia regimen. The operations included procedures on the aorta, stomach, biliary tract, or colon.
Patients in group 1 received general anesthesia followed by postoperative parenteral opioid analgesia. Patients in group 2 received epidural plus light general anesthesia combined with postoperative epidural morphine.
Overall, the incidence of death and major complications did not differ between the groups, the authors note. However, for patients undergoing aortic procedures, the epidural regimen was associated with a significantly lower risk of death and major complications. This finding resulted from a lower incidence of new myocardial infarction, stroke, and respiratory failure in group 2.
Despite receiving significantly less analgesic medication, group 2 patients reported better pain relief than did group 1 patients, the investigators state. Among aortic surgery patients, the epidural regimen was associated with a shorter intubation time and surgical intensive care unit stay.
The findings suggest that the effect of anesthetic/analgesic regimens on perioperative outcomes varies according to the type of procedure performed, the researchers point out.
"Further studies are needed not only to distinguish the impact of intraoperative epidural anesthesia from that of postoperative analgesia but also to establish the impact of specific agents and modes of opioid analgesia within the systemic or epidural groups on outcome," Dr. Thompson's team concludes.
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