Thoracic epidural anaesthesia and analgesia ameliorates surgery-induced stress response and postoperative pain in patients undergoing radical oesophagectomy

Abstract

Objective An acute severe stress response associated with major surgery can adversely affect the inflammatory and hormonal responses. We hypothesised that total intravenous anaesthesia (TIVA) combined with thoracic epidural anaesthesia and analgesia (TEA) attenuates the stress response and postoperative pain in patients undergoing radical oesophagectomy. Methods Forty patients scheduled for elective radical oesophagectomy were randomly assigned to one of two groups: TIVA or TIVA+TEA. The plasma levels of stress hormones and cytokines, consumption of fentanyl, postoperative visual analogue scale (VAS) scores within 48 hours, and extubation time were assessed. Results The plasma levels of interleukin-6, norepinephrine, cortisol, and adrenocorticotropic hormone at 3 hours after the beginning of surgery were significantly higher in the TIVA group than TIVA+TEA group. The plasma level of interleukin-10 at 3 hours after the beginning of surgery was significantly lower in the TIVA group than TIVA+TEA group. The consumption of fentanyl was significantly greater, VAS scores were significantly higher, and extubation time was significantly longer in the TIVA group than TIVA+TEA group. Conclusions The findings suggest that combination of TIVA and TEA may attenuate the intraoperative stress response and postoperative pain in patients undergoing radical oesophagectomy.

Epidural analgesia and mortality after colorectal cancer surgery: A retrospective cohort study

“…EA is presumed to decrease postoperative complications associated with immobility, such as pneumonia and deep vein thrombosis [ 15 ], and to ameliorate gastrointestinal motility after abdominal surgery facilitating earlier oral nutrition intake [ 3 , 16 ]. Furthermore, EA has been shown to reduce the stress response caused by the surgical trauma [ 1 ], as well as postoperative immune suppression [ 17 , 18 ]. Despite these reported benefits, EA is currently only recommended after open surgery, and not after minimally invasive procedures [ 7 ].…”

“…Epidural Analgesia (EA) reduces the stress response to surgical trauma [ 1 ], provides superior pain relief after major open surgical (OS) procedures compared to intravenous opioid analgesia [ 2 ], and may reduce opioid-mediated immune suppression [ 3 , 4 ]. Laparoscopic or robotically assisted minimally invasive surgery (MIS) are increasingly used in the resection of colorectal tumors [ 5 ].…”

Dexmedetomidine for prevention of postoperative delirium in older adults undergoing oesophagectomy with total intravenous anaesthesia

“…Both thoracic epidural anaesthesia (TEA) and paravertebral block (PVB) proved to be effective in improving analgesia, lowering the inflammatory response and decreasing the occurrence of delirium in patients undergoing oesophagectomy. 2,3 TEA and PVB provide satisfactory analgesia and reduce postoperative pulmonary atelectasis, which may be one of the mechanisms by which regional anaesthesia alleviates POD. The open transthoracic approach also allows the surgeon to place an epidural catheter directly inside the paravertebral space, guaranteeing an adequate positioning of the catheter.…”

Anaesthesia as an influence in tumour progression

“…Both revealed a reduced stress response with the use of an epidural anaesthesia [ 55 , 56 ]. In detail, a reduction of IL-6, norepinephrine, cortisol, and adrenocorticotropic hormone (ACTH) was shown in combination with a higher secretion of IL-10, 3 h after surgery [ 57 ]. These results could not be confirmed in colorectal cancer [ 58 ].…”