Colonic resection with early discharge after combined subarachnoid-epidural analgesia, preoperative glucocorticoids, and early postoperative mobilization and feeding in a pulmonary high-risk patient.
OBJECTIVE
A pulmonary high-risk patient undergoing right hemicolectomy for cancer was treated with a combination of intense afferent neural block with subarachnoid-epidural local anesthetics followed by continuous epidural analgesia, preoperative high-dose glucocorticoids, and early oral feeding and mobilization.


METHODS
Intraoperative subarachnoid anesthesia was followed by epidural analgesia with bupivacaine and morphine for 72 hours and oral acetaminophen 1 g every 6 hours.


RESULTS
The technique resulted in a pain-free postoperative course (rest and mobilization) with unchanged pulmonary function. Nocturnal episodic oxygen desaturation, hyperthermia, and postoperative fatigue were prevented. Defecation occurred on the first postoperative day and oral caloric intake was normal after 24 hours with no postoperative weight loss. Self care was normalized on the third postoperative day and the patient discharged from the hospital 80 hours after surgery.


CONCLUSIONS
The technique of combined neural and humoral mediator block should be evaluated in other high-risk patients undergoing major surgical procedures, where minimal invasive techniques are not possible.
Department of Anesthesiology, Hvidovre University Hospital, Copenhagen, Denmark.
S
S
Møiniche
J B
JB
Dahl
J
J
Rosenberg
H
H
Kehlet
D015360:Analgesia, Epidural / Q000379:methods*; D000779:Anesthetics, Local; D003106:Colon / Q000601:surgery*; D003110:Colonic Neoplasms / Q000601:surgery*; D004305:Dose-Response Relationship, Drug; D004434:Early Ambulation; D004435:Eating / Q000502:physiology*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007902:Length of Stay; D008168:Lung / Q000502:physiology*; D008875:Middle Aged; D009407:Nerve Block; D009475:Neurons, Afferent; D010351:Patient Discharge; D011182:Postoperative Care; D011300:Preoperative Care; D012307:Risk Factors; D013346:Subarachnoid Space
D000779:Anesthetics, Local; D005938:Glucocorticoids