title: Epidural analgesia for cytoreductive surgery with peritonectomy and heated intraperitoneal chemotherapy.
abstract: OBJECTIVE
  To evaluate epidural analgesia role after cytoreductive surgery with peritonectomy combined with heated intraperitoneal chemotherapy.
  
  
  METHODS
  101 patients were retrospectively studied (between 2008 and 2012) to evaluate epidural analgesia effectiveness, tolerability and safety in this surgical context through the assessment of pain, detection of adverse events (nausea, vomiting, itching), temporary motor block, respiratory failure and coagulation profile in the post-operative period.
  
  
  RESULTS
  The median duration of epidural analgesia was 5 [range 1-10] days. As regards pain relief, the median verbal numerical scale scores at rest and on movement were below 2 and 5 until the fifth post-operative day, respectively. 13% of patients suffered nausea, 4% vomit, and 1% itching. No bradycardia or respiratory failure event was reported. 9.9% of patients had hypotension episodes. Coagulation reached normality only 3-4 days after surgery. 5 risky accidental dislodgments of epidural catheter occurred (prothrombine time INR > 1.5) without neurological complications.
  
  
  CONCLUSIONS
  Epidural analgesia ensures adequate pain relief and is well tolerated by patients after cytoreductive surgery with peritonectomy combined with heated intraperitoneal chemotherapy. Hypotension is common in this context and careful monitoring of coagulation parameters, especially in the first 3 days after surgery, is advisable to reduce the risk of neuraxial complications.
authors.affiliation: Department of Anesthesia, Intensive Care and Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, 20080, Italy. Electronic address: federico.piccioni@istitutotumori.mi.it.
authors.forename: Federico
authors.initials: F
authors.lastname: Piccioni
authors.affiliation: School of Anesthesia and Intensive Care, University of Milan, Via Festa del Perdono 7, Milan, 20122, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Casiraghi
authors.affiliation: Department of Anesthesia, Intensive Care and Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, 20080, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Fumagalli
authors.affiliation: Colorectal Cancer Unit-Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, 20080, Italy.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kusamura
authors.affiliation: Colorectal Cancer Unit-Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, 20080, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Baratti
authors.affiliation: Colorectal Cancer Unit-Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, 20080, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Deraco
authors.affiliation: Immunohematology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, 20080, Italy.
authors.forename: Flavio
authors.initials: F
authors.lastname: Arienti
authors.affiliation: Department of Anesthesia, Intensive Care and Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, 20080, Italy; Department of Pathophysiology and Transplantation, University of Milan, Via Festa del Perdono 7, Milan, 20122, Italy.
authors.forename: Martin
authors.initials: M
authors.lastname: Langer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000009:adverse effects; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000628:therapy*; D010534:Peritoneal Neoplasms / Q000628:therapy*; D010537:Peritoneum / Q000601:surgery*; D012189:Retrospective Studies
keywords: Analgesia, epidural; Blood coagulation disorder; Hyperthermic intraperitoneal chemotherapy; Pain, postoperative