Combined general-epidural anesthesia with continuous postoperative epidural analgesia preserves sigmoid colon perfusion in elective infrarenal aortic aneurysm repair

Zhong²,

et al. 2019

Oncol Lett

Application value of epidural anesthesia combined with epidural analgesia and general anesthesia combined with intravenous analgesia in ovarian cancer surgery was explored. In total 298 ASA I–III grade patients with ovarian cancer, undergoing extensive total hysterectomy and pelvic lymphotomy, were retrospectively analyzed. Patients were divided into two groups: the epidural anesthesia combined with epidural analgesia group (group A, 158 cases), and the general anesthesia combined with intravenous analgesia group (group B, 140 cases). The first exhaust time, incidence of adverse reactions, Aldrete score, and recovery were observed, and the visual analogue scale (VAS) scores during resting, exercise and cough at 24 h after surgery were recorded. Fasting venous blood (2 ml) was drawn at the same time before anesthesia and at 24 h after anesthesia in both groups to determinate cortisol (COR) and C-reactive protein (CRP) levels. The first exhaust time and incidence of adverse reactions in group A were significantly lower than those in group B (P<0.05). The Aldrete score and extubation time (ET) in group A were significantly higher than that in group B. Eye opening time (EOT), recovery orientation time (ROT) and post-anesthesia care unit (PACU) time in group A were significantly lower than those in group B (P<0.05). The VAS scores in group A during resting, exercise and cough were lower than those in group B (P<0.05). Compared with before anesthesia, the levels of COR and CRP increased significantly in both groups at 24 h after anesthesia (P<0.05), while the level of COR and CRP in group A was significantly lower than that in group B, at 24 h after surgery (P<0.05). Epidural anesthesia combined with epidural analgesia has better analgesic effect, higher safety, lower incidence of adverse reactions, and is beneficial to the recovery of patients with ovarian cancer after radical operation when compared with general anesthesia combined with intravenous analgesia.

Section: Discussionsupporting

confidence: 92%

Comparison between the effect of epidural anesthesia combined with epidural analgesia and general anesthesia combined with intravenous analgesia on prognosis of ovarian cancer patients

Zhong²,

et al. 2019

Oncol Lett

Cochrane Database of Systematic Reviews

Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery

Guay

Kopp

2016

Open Abdominal Aortic Aneurysm Repair

Cobb¹,

Dangler²,

Robinson³

2019

Acute Pain Medicine

This chapter describes the significant challenge that open repair of abdominal aortic aneurysms poses for acute pain medicine physicians. In particular, acute pain medicine physicians must have a solid understanding of ischemic pain mechanisms and temporizing analgesic strategies. Epidural analgesia is often optimal for postoperative pain control, but risks must be weighed in the setting of commonly used anticoagulants in this population. Patient-controlled opioid-based analgesia is an option; an advantage of its use is that the patient typically spends less time in pain and tends to use less medication than when medication is given according to a set schedule. However, it is characterized by numerous concerns related to safety and adverse events; if the PCA device is not programmed properly, it can result in the under- or overdosing of narcotics.