title: [Epidural analgesia for surgical treatment of peritoneal carcinomatosis: a risky technique?].
abstract: BACKGROUND
  To study the risks of haemodynamic instability, and the possible occurrence of spinal haematoma, meningitis and epidural abscess when epidural analgesia is performed for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC).
  
  
  METHODS
  We retrospectively analyzed the data of 35 patients treated by HIPEC with oxaliplatin or cisplatin. An epidural catheter was inserted before induction of general anaesthesia. Postoperatively, a continuous epidural infusion of ropivacain, then a patient-controlled epidural analgesia were started.
  
  
  RESULTS
  The epidural catheter was used peroperatively before HIPEC in 12 subjects (34%), and after HIPEC in 23 subjects (66%). The median dose of ropivacain given peroperatively in the epidural catheter was 40 mg (30-75). Norepinephrin was used in two subjects (6%) peroperatively (median infusion rate 0.325 μg/kg per minute [0.32-0.33]), and in four subjects (11%) in the postoperative 24 hours. No spinal haematoma, meningitis or epidural abscess were noted. Five subjects (14%) had a thrombopenia or a prothrombin time less than 60% before catheter removal. Two subjects (6%) had a leukopenia before catheter removal. No thrombopenia or blood coagulation disorders were recorded the day of catheter removal.
  
  
  CONCLUSIONS
  In this series of 35 patients, the use of epidural analgesia for HIPEC does not seem to be associated with a worse risk of haemodynamic instability, spinal haematoma, meningitis or epidural abscess. HIPEC with platinum salt is not incompatible with the safety of epidural analgesia, with an optimized fluid management peroperatively and the following of perimedullary anesthesia practice guidelines.
authors.affiliation: Département d'anesthésie-réanimation, centre régional de lutte contre le cancer Léon-Bérard, Lyon, France. fp_desgranges@yahoo.fr
authors.forename: F-P
authors.initials: FP
authors.lastname: Desgranges
authors.forename: A
authors.initials: A
authors.lastname: Steghens
authors.forename: H
authors.initials: H
authors.lastname: Rosay
authors.forename: P
authors.initials: P
authors.lastname: Méeus
authors.forename: A
authors.initials: A
authors.lastname: Stoian
authors.forename: A-L
authors.initials: AL
authors.lastname: Daunizeau
authors.forename: S
authors.initials: S
authors.lastname: Pouderoux-Martin
authors.forename: V
authors.initials: V
authors.lastname: Piriou
mesh_terms: D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods*; D016058:Analgesia, Patient-Controlled; D000768:Anesthesia, General; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002277:Carcinoma / Q000188:drug therapy / Q000601:surgery*; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D020802:Epidural Abscess / Q000453:epidemiology / Q000209:etiology; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000453:epidemiology / Q000209:etiology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008581:Meningitis / Q000453:epidemiology / Q000209:etiology; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D000077150:Oxaliplatin; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000601:surgery*; D012189:Retrospective Studies; D012306:Risk; D012449:Safety; D013921:Thrombocytopenia / Q000209:etiology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D014662:Vasoconstrictor Agents; D000077150:Oxaliplatin; D002945:Cisplatin; D009638:Norepinephrine