title: Dual-epidural catheter technique and perioperative outcomes after Ivor-Lewis esophagectomy.
abstract: BACKGROUND
  Ivor-Lewis esophagectomy is associated with significant postoperative analgesic requirements and perioperative complications. A dual-epidural technique may improve perioperative outcomes compared with single thoracic epidural analgesia.
  
  
  METHODS
  This study identified all cases of Ivor-Lewis esophagectomy over a 3-year period. Eighty-one patients undergoing Ivor-Lewis esophagectomy who received general anesthesia supplemented by neuraxial analgesia with dual-epidural catheters (DECs) were matched 1:1 with patients who received general anesthesia and a single thoracic epidural catheter. Primary outcomes included quality of analgesia at rest and with movement on each of the first 3 postoperative days. Secondary outcomes included adverse events and the incidence of 4 major postoperative complications (anastomotic leak, pulmonary complications, atrial fibrillation, and sepsis).
  
  
  RESULTS
  A DEC technique significantly improved analgesia (evidenced by reduced pain with movement on each of the first 3 postoperative days) when compared with a single epidural catheter technique. The placement of DECs did not increase catheter-related adverse events. A DEC technique was associated with a 50% reduction in the combined rate of major postoperative complications (36% vs. 18%; odds ratio, 0.40; P = 0.01) and increased number of hospital-free days measured at day 28 (21.2 vs. 22.3; P = 0.04).
  
  
  CONCLUSIONS
  The DEC technique improved postoperative analgesia and reduced the incidence of major postoperative complications and hospital length of stay in patients undergoing Ivor-Lewis esophagectomy. Future studies should evaluate the efficacy of this technique in a controlled randomized clinical trial.
authors.affiliation: Department of Anesthesiology and Division of Thoracic Surgery, Mayo Clinic, Rochester, MN 55905, USA. brown.michael3@mayo.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Brown
authors.forename: Daryl J
authors.initials: DJ
authors.lastname: Kor
authors.forename: Mark S
authors.initials: MS
authors.lastname: Allen
authors.forename: Michelle O
authors.initials: MO
authors.lastname: Kinney
authors.forename: K Robert
authors.initials: KR
authors.lastname: Shen
authors.forename: Claude
authors.initials: C
authors.lastname: Deschamps
authors.forename: Francis C
authors.initials: FC
authors.lastname: Nichols
authors.forename: William D
authors.initials: WD
authors.lastname: Mauck
authors.forename: Carlos B
authors.initials: CB
authors.lastname: Mantilla
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D057785:Catheters; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged