[Effect of thoracic epidural analgesia on the early postoperative phase after interventions on the gastrointestinal tract].
BACKGROUND
Thoracic epidural anesthesia is increasingly being used in visceral surgery as an adjuvant to general anesthesia and, in addition, as a postoperative method of thoracic epidural analgesia (TEA). This method interrupts specifically nociceptive reflexes, increases the blood supply by blocking sympathetic activation, improves pulmonary function, and has a beneficial effect on gastrointestinal (GI) motility.


METHODS
A retrospective study was conducted on 175 patients with a primary GI carcinoma operated between January 1, 1999 and December 31, 1999; 78 operations were performed on the upper GI tract (UGI, gastrectomy), and 97 on the lower GI tract (LGI, anterior rectum resection). The postoperative course in patients with and without TEA was compared. For intraoperative and postoperative catheter analgesia, bupivacaine (intraoperative: 0.25%; postoperative: 0.125%) and fentanyl were used. General anesthesia was administered as balanced anesthesia.


RESULTS
A total of 102 patients received combined anesthesia with TEA (UGI n = 61/LGI n = 41) and 73 patients were given general anesthesia with continuous postoperative, intravenous pain therapy or a patient-controlled analgesia (PCA) pump (UGI n = 17/LGI n = 56). There was no difference between the groups with and without TEA in terms of initial demographic details, such as age distribution, tumor stage or ASA classification. Under TEA, the length of stay in the intensive care unit (P < 0.01), the administration of antibiotics (P < 0.001), days without oral nutrition (p < 0.05) and the rate of anastomosis insufficiencies (P < 0.001) was significantly reduced after operations on the upper GI tract. After surgery on the lower GI tract, the use of TEA led to less frequent vomiting and earlier resumption of GI motility (P < 0.01). However, these positive effects did not have a significant beneficial impact on overall hospitalization.


CONCLUSIONS
The combination of TEA and general anesthesia has been shown to offer advantages after operations on both the upper and the lower GI tract. The positive effects of the TEA in the postoperative period should be used for the early enteric nutrition and mobilization of patients.
Zügel
N
N
Klinik für Allgemein- und Viszeralchirurgie, Klinikum Augsburg, Stenglinstasse 2, 86156 Augsburg. surgaugs@klinikum-augsburg.de
Bruer
C
C
Breitschaft
K
K
Angster
R
R
D000368:Aged; D015360:Analgesia, Epidural; D002045:Bupivacaine; D003422:Critical Care; D004434:Early Ambulation; D004750:Enteral Nutrition; D005260:Female; D005283:Fentanyl; D005769:Gastrointestinal Motility / Q000187:drug effects; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D011184:Postoperative Period
D005283:Fentanyl; D002045:Bupivacaine