Association between thoracic epidural block and major complications after pleurectomy/decortication for malignant pleural mesothelioma under general anesthesia

Abstract

IntroductionA curative-intent surgical procedure, pleurectomy/decortication, for malignant pleural mesothelioma is accompanied by a high incidence of major postoperative complications. Although epidural block, which suppresses nociception during and after surgery, reportedly has both benefits and disadvantages in terms of outcomes after thoracic surgery for other diseases, the effects of epidural block on major complications after pleurectomy/decortication have not been evaluated. The aim of this study was to evaluate the association between epidural block and major postoperative complications following pleurectomy/decortication.MethodsIn a single-institutional observational study, consecutive adult patients undergoing pleurectomy/decortication under general anesthesia were enrolled from March 2019 to December 2021. Multivariable logistic regression analysis was performed to determine the association between perioperative variables and major complications. Next, patients were divided into two groups: general anesthesia with and without epidural block. Incidences of major postoperative complications, defined as Clavien-Dindo grades≥III, were compared between groups.ResultsIn all patients enrolled with American Society of Anesthesiologists (ASA) physical status II or III (n=99), general anesthesia without epidural block was identified as a sole risk factor for major complications among perioperative variables. The incidence of major complications was 32.3% (95% CI 19.1% to 49.2%) in patients with epidural block (n=34), which was significantly lower than 63.1% (95% CI 50.9% to 73.8%) in patients with epidural block (n=65). In sensitivity analysis in patients with ASA physical status II alone, the same results were obtained.ConclusionEpidural block is likely associated with reduction of the incidence of major complications after pleurectomy/decortication for malignant pleural mesothelioma under general anesthesia.

Intraoperative Assessment of Surgical Stress Response Using Nociception Monitor under General Anesthesia and Postoperative Complications: A Narrative Review

“…Higher values of NR averaged from the start to the end of surgery (mean NR), which are calculated using heart rate, systolic blood pressure, and peripheral perfusion index, were reportedly associated with a higher incidence of major postoperative complications, defined as a Clavien–Dindo Class ≥ IIIa, after gastrointestinal surgery ( Table 1 ) [ 44 ]. Mean NR values also increased in the order of severity of postoperative complications in patients undergoing total shoulder arthroplasty, gastrointestinal surgery, and thoracic surgery ( Figure 2 ) [ 44 , 45 , 46 , 84 , 85 ].…”

“…Gray circles show individual data points. Data in this graph were obtained from [ 44 , 45 , 46 , 84 , 85 ]. Significant differences are defined at * p < 0.001 vs. no complications, and # p < 0.001 vs. minor complications.…”

Intraoperative nociception and postoperative inflammation associated with the suppression of major complications due to thoracic epidural block after pleurectomy/decortication for malignant pleural mesothelioma under general anesthesia: A retrospective observational study

“…The study includes patients who underwent P/D from January 2022 to April 2022, as well as those included in our previous study from March 2019 to December 2021. [ 4 ] While the duration of patient enrollment in the present study was longer than in the previous study, [ 4 ] the number of analyzed patients in the present study was smaller due to a large volume of missing data on differential WBC counts. Further investigations are needed to determine the precise mechanisms by which TEB exerts suppressive effects on major complications after P/D in a prospective randomized controlled study in the future.…”

“…A previous study reported that the incidence of postoperative complications, defined as Clavien-Dindo grade ≥ III, was 32.3 % in patients with TEB and 63.1% in patients without TEB. [4] We thus assumed that the probabilities www.md-journal.com of postoperative complications were 30% and 60% in patients with or without TEB in the present study. Required sample size was then estimated to be 42 participants in each group and 84 in total.…”

“…[ 2 , 3 ] A recent study demonstrated that the incidence of major complications after P/D was 32.3% in patients with thoracic epidural block (TEB), which was significantly lower than 63.1% in patients without TEB under general anesthesia. [ 4 ] The underlying mechanisms of associations between TEB and the inhibitory rate of postoperative major complications, however, have not been revealed.…”