title: Local versus epidural anesthesia in fast-track abdominal aortic surgery.
abstract: OBJECTIVE
  The aim of this study was to investigate a possible alternative to epidural anesthesia/analgesia. The authors compared thoracic epidural anesthesia/analgesia with continuous wound infiltration anesthesia/analgesia in patients scheduled for mini-invasive abdominal aortic surgery in a fast-track setting.
  
  
  METHODS
  A prospective randomized study.
  
  
  METHODS
  A university hospital.
  
  
  METHODS
  Sixty patients undergoing fast-track abdominal aortic surgery.
  
  
  METHODS
  The authors compared thoracic epidural infusion (the PERI group) with continuous local wound infiltration (the LOC group) for anesthesia/analgesia. Pain scores, the resumption of oral feeding, the resumption of ambulation, the day of discharge, and postoperative complications in the immediate (ie, 30 days) and long-term periods (ie, 2 years) were evaluated.
  
  
  RESULTS
  Pain scores were low in both groups. The intraoperative LOC group needed higher doses of anesthetic/analgesic drugs. The postoperative LOC group needed significantly higher doses of bupivacaine (3.9 ± 0.7 mL/h [PERI group] and 5.7 ± 1.3 mL/h [LOC group] on day 0 [p < 0.01]; 3.8 ± 0.8 mL/h [PERI group] and 5.3 ± 1 mL/h [LOC group] on day 1 [p < 0.01]). The parameters of postoperative recovery were comparable between the 2 groups in terms of the resumption of ambulation after surgery (within 3 hours), feeding (within 6 hours), the passage of stools (mean 2 days), and the median hospital stay (3 days). In the 2-year follow-up period, a difference between the 2 groups in the incidence of wound complications was not observed.
  
  
  CONCLUSIONS
  The results obtained showed good and similar pain control in the 2 groups, but the LOC group required higher doses of anesthetic/analgesic drugs. Parameters of the postoperative recovery were similar in both groups.
authors.affiliation: Department of Anaesthesia, University Hospital Maggiore della Carità, Novara, Italy. piero.brustia@maggioreosp.novara.it
authors.forename: Alessandra
authors.initials: A
authors.lastname: Renghi
authors.forename: Luca
authors.initials: L
authors.lastname: Gramaglia
authors.forename: Francesco
authors.initials: F
authors.lastname: Casella
authors.forename: Diego
authors.initials: D
authors.lastname: Moniaci
authors.forename: Katia
authors.initials: K
authors.lastname: Gaboli
authors.forename: Piero
authors.initials: P
authors.lastname: Brustia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D001012:Aorta, Abdominal / Q000601:surgery*; D001794:Blood Pressure / Q000502:physiology; D004434:Early Ambulation; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D008991:Monitoring, Physiologic; D059408:Pain Management; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology / Q000628:therapy; D011446:Prospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*
chemical_list: D000779:Anesthetics, Local