title: Epidural anesthesia dysfunction is associated with postoperative complications after pancreatectomy.
abstract: BACKGROUND
  Epidural anesthesia is an accepted measure of pain control after major abdominal surgery. However, if the epidural anesthesia is unsuccessful, a variety of adverse effects can occur - excessive stress response, poor patient mobilization, increased opioid use, and hypotension due to vasodilation. The aim of this study was to evaluate the influence of epidural dysfunction on outcomes after pan-createctomy.
  
  
  METHODS
  Between August 2010 and October 2014, 72 patients underwent open pancreatectomy with epidural anesthesia. Epidural dysfunction was defined as either hypo-function due to inadequate pain control (requirement of epidural replacement, conversion to intravenous continuous opioid infusion, or intravenous bolus opioid use) or hyper-function (hypotension or oliguria). We then analyzed for an association between epidural dysfunction and surgical outcomes.
  
  
  RESULTS
  Epidural dysfunction occurred in 49% after pancreatectomy - hypo-function in 35% and hyper-function in 14%. Epidural dysfunction was independently associated with the development of overall (P < 0.001), pancreas-related (P = 0.041), and non-pancreas-related complications (P = 0.001). Hypo-function alone was independently associated with both pancreas-related (P = 0.015) and non-pancreas-related complications (P = 0.004). Hyper-function was independently associated with non-pancreas-related complications (P = 0.002).
  
  
  CONCLUSIONS
  Outcomes after pancreatic resection can be improved by increasing the success rate of epidural anesthesia.
authors.affiliation: Center for Pancreatic and Liver Disease, St. Luke's Health System, 100 East Idaho Street, Suite 301, Boise, Idaho, 83712, USA. msugimot7@gmail.com.
authors.forename: Motokazu
authors.initials: M
authors.lastname: Sugimoto
authors.affiliation: Center for Pancreatic and Liver Disease, St. Luke's Health System, 100 East Idaho Street, Suite 301, Boise, Idaho, 83712, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Nesbit
authors.affiliation: Center for Pancreatic and Liver Disease, St. Luke's Health System, 100 East Idaho Street, Suite 301, Boise, Idaho, 83712, USA.
authors.forename: Joshua G
authors.initials: JG
authors.lastname: Barton
authors.affiliation: Center for Pancreatic and Liver Disease, St. Luke's Health System, 100 East Idaho Street, Suite 301, Boise, Idaho, 83712, USA.
authors.forename: L William
authors.initials: LW
authors.lastname: Traverso
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural / Q000009:adverse effects; D002404:Catheterization; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D011183:Postoperative Complications; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Epidural analgesia; Epidural anesthesia; Pancreatectomy; Postoperative complication