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Yu J, Zheng T, Yuan A, Wang W, Li Z, Cao S. The Role of Patient-Controlled Epidural Analgesia in the Short-Term Outcomes of Laparoscopic-Assisted Gastrectomy in Elderly Gastric Cancer Patients. J Surg Res 2025; 306:257-265. [PMID: 39809036 DOI: 10.1016/j.jss.2024.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 09/24/2024] [Accepted: 11/15/2024] [Indexed: 01/16/2025]
Abstract
INTRODUCTION Patient-controlled intravenous analgesia (PCIA) and patient-controlled epidural analgesia (PCEA) constitute two major advances in pain management after major abdominal surgery. However, the role of PCIA or PCEA has not been particularly studied in elderly patients with gastric cancer. The aim of this study is to make a comparison between PCIA and PCEA in terms of their performance on short-term outcomes in elderly patients undergoing laparoscopic-assisted gastrectomy. METHODS This single-center, retrospective study included 254 elderly patients (≥70 y) who underwent laparoscopic radical gastrectomy for gastric cancer. Patients received either general anesthesia combined with epidural anesthesia followed by PCEA (PCEA group, n = 123) or general anesthesia alone followed by PCIA (PCIA group, n = 131). The primary endpoint was pain intensity-tested using a 100-mm visual analog scale on postoperative days 1, 2, and 3. Demographics, comorbidities, perioperative data, postoperative short-term outcomes, and analgesia-related side effects were also assessed. RESULTS The visual analog scale scores at rest were lower in the PCEA group compared to the PCIA group on postoperative day 1, 2, and 3 (27.8 ± 13.9 versus 33.1 ± 15.0, P = 0.004; 25.2 ± 11.3 versus 30.1 ± 14.3, P = 0.002; 16.9 ± 7.1 versus 20.9 ± 9.5, P < 0.001, respectively). The postoperative hospital stay was shorter in the PCEA group than in the PCIA group (11 versus 12 d, P = 0.018). The times to postoperative first flatus, semifluid diet, independent ambulation, and tracheal extubation after surgery in the PCEA group were significantly shorter than in the PCIA group. Overall morbidity, mortality, hospital readmission rate, and reoperation rate were not significantly different between the two groups. Regarding side-effects related to analgesia, there were no significant differences in terms of the rates of postoperative nausea and vomiting, urinary retention, or oxygen saturation <90% between the two groups. However, PCEA was associated with a higher incidence of postoperative hypotension compared to PCIA (10.6% versus 3.8%, P = 0.036). CONCLUSIONS In elderly patients undergoing laparoscopic radical gastrectomy, epidural anesthesia and analgesia may convey superior pain relief, faster restoration of gastrointestinal motility, and shorter hospitalization.
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Affiliation(s)
- Junjian Yu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Taohua Zheng
- Liver Disease Center, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Antai Yuan
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Wei Wang
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zequn Li
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shougen Cao
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
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Ebara G, Sakuramoto S, Matsui K, Nishibeppu K, Fujita S, Fujihata S, Oya S, Lee S, Miyawaki Y, Sugita H, Sato H, Yamashita K. Efficacy and safety of patient-controlled thoracic epidural analgesia alone versus patient-controlled intravenous analgesia with acetaminophen after laparoscopic distal gastrectomy for gastric cancer: a propensity score-matched analysis. Surg Endosc 2023; 37:8245-8253. [PMID: 37653160 DOI: 10.1007/s00464-023-10370-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/30/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Laparoscopic gastrectomy is a common procedure for early gastric cancer treatment. Improving postoperative pain control enhances patient recovery after surgery. The use of multimodal analgesia can potentially enhance the analgesic effect, minimize side effects, and change the postoperative management. The purpose of this study was to evaluate and compare the efficacies of the use of patient-controlled intravenous analgesia with regular acetaminophen (PCIA + Ace) and patient-controlled thoracic epidural analgesia (PCEA) for postoperative pain control. METHODS We retrospectively collected the data of 226 patients who underwent laparoscopic distal gastrectomy (LDG) with delta-shaped anastomosis between 2016 and 2019. After 1:1 propensity-score matching, we compared 83 patients who used PCEA alone (PCEA group) with 83 patients who used PCIA + Ace (PCIA + Ace group). Postoperative pain was assessed using a numeric rating scale (NRS) with scores ranging from 0 to 10. An NRS score ≥ 4 was considered the threshold for additional intravenous rescue medication administration. RESULTS Although NRS scores at rest were comparable between the PCEA and PCIA + Ace groups, NRS scores of patients in the PCIA + Ace group during coughing or movement were significantly better than those of patients in the PCEA group on postoperative days 2 and 3. The frequency of additional rescue analgesic use was significantly lower in the PCIA + Ace group than in the PCEA group (1.1 vs. 2.7, respectively, p < 0.001). The rate of reduction or interruption of the patient-controlled analgesic dose was higher in the PCEA group than in the PCIA + Ace group (74.6% vs. 95.1%, respectively, p = 0.0002), mainly due to hypotension occurrence in the PCEA group. Physical recovery time, postoperative complication occurrence, and liver enzyme elevation incidence were not significantly different between groups. CONCLUSIONS PCIA + Ace can be safely applied without an increase in complications or deterioration in gastrointestinal function; moreover, PCIA + Ace use may provide better pain control than PCEA use in patients following LDG.
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Affiliation(s)
- Gen Ebara
- Division of Digestive Surgery, Department of Gastroenterological Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan.
| | - Shinichi Sakuramoto
- Division of Digestive Surgery, Department of Gastroenterological Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Kazuaki Matsui
- Division of Digestive Surgery, Department of Gastroenterological Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Keiji Nishibeppu
- Division of Digestive Surgery, Department of Gastroenterological Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Shouhei Fujita
- Division of Digestive Surgery, Department of Gastroenterological Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Shiro Fujihata
- Division of Digestive Surgery, Department of Gastroenterological Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Shuichiro Oya
- Division of Digestive Surgery, Department of Gastroenterological Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Seigi Lee
- Division of Digestive Surgery, Department of Gastroenterological Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Yutaka Miyawaki
- Division of Digestive Surgery, Department of Gastroenterological Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Hirofumi Sugita
- Division of Digestive Surgery, Department of Gastroenterological Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Hiroshi Sato
- Division of Digestive Surgery, Department of Gastroenterological Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Keishi Yamashita
- Division of Advanced Surgical Oncology, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan
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Wang S, Xu Y, Kang Y, Qin Z, Peng C, Lin H. Effect of different analgesic treatments on the pulmonary function in elderly hip fracture patients: A prospective study. Medicine (Baltimore) 2023; 102:e34505. [PMID: 37603509 PMCID: PMC10443746 DOI: 10.1097/md.0000000000034505] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/05/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND To investigate the effect of different analgesic methods on lungs in elderly patients with hip fractures. METHODS A prospective study was conducted on 78 elderly hip fracture patients undergoing spinal anesthesia for surgery, where 3 analgesic methods were used: postoperative Patient-controlled intravenous analgesia pump (PCIA) (group I), pre and postoperative PCIA (group II), and preoperative fascia iliaca compartment block (FICB) + postoperative PCIA (group III). The following indicators were monitored at admission (T1), on the day of surgery before anesthesia (T2), and 7 days after surgery (T3): heart rate (HR), respiratory rate (RR), forced expiratory volume during the first second, arterial partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2), C-reactive protein (CRP), and interleukin 6 (IL-6). Pulmonary complications such as pulmonary atelectasis and respiratory insufficiency were analyzed. RESULTS The HR, RR, forced expiratory volume during the first second, PaO2, PaCO2, IL-6, and CRP levels at T1 after fracture did not significantly differ among the 3 groups (P > .05). After different analgesic treatments post-admission, all indicators at T2 were significantly higher in group I than in groups II and III (P < .05), while there was no significant difference between groups II and III (P > .05). At T3, there were no significant differences in RR, HR, PaO2, PaCO2, and CRP levels among the groups (P > .05), but IL-6 levels at T3 were significantly higher in group I than in groups II and III (P < .05). CONCLUSION The use of effective pain relief during surgery can help protect the lung function of elderly patients with hip fractures. When using PCIA with FICB before surgery, respiratory performance may be better protected compared to using unsustained analgesia. This could be due to a decrease in the levels of inflammatory markers such as CRP and interleukin-6.
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Affiliation(s)
- Shunhong Wang
- Department of Anesthesiology, 958 Hospital of Army, Chongqing, China
| | - Yueming Xu
- Department of Anesthesiology, 958 Hospital of Army, Chongqing, China
| | - Yongjian Kang
- Department of Anesthesiology, 958 Hospital of Army, Chongqing, China
| | - Zhigang Qin
- Department of Anesthesiology, 958 Hospital of Army, Chongqing, China
| | - Chunyu Peng
- Department of Anesthesiology, 958 Hospital of Army, Chongqing, China
| | - Hong Lin
- Department of Anesthesiology, 958 Hospital of Army, Chongqing, China
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Jang YK, Kim NY, Lee JS, Shin HJ, Kim HG, Lee SW, Koh JC, Yoo YC. Comparison of Postoperative Pain and Adverse Effects between Variable-Rate Feedback Infusion and Conventional Fixed-Rate Basal Infusion Modes of Patient-Controlled Epidural Analgesia following Open Gastrectomy: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168777. [PMID: 34444526 PMCID: PMC8391703 DOI: 10.3390/ijerph18168777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/10/2021] [Accepted: 08/15/2021] [Indexed: 11/16/2022]
Abstract
Patient-controlled epidural analgesia is widely used to control postoperative pain following major intra-abdominal surgeries. However, determining the optimal infusion dose that can produce effective analgesia while reducing side effects remains a task to be solved. Postoperative pain and adverse effects between variable-rate feedback infusion (VFIM group, n = 36) and conventional fixed-rate basal infusion (CFIM group, n = 36) of fentanyl/ropivacaine-based patient-controlled epidural analgesia were evaluated. In the CFIM group, the basal infusion rate was fixed (5 mL/h), whereas, in the VFIM group, the basal infusion rate was increased by 0.5 mL/h each time a bolus dose was administered and decreased by 0.3 mL/h when a bolus dose was not administered for 2 h. Patients in the VFIM group experienced significantly less pain at one to six hours after surgery than those in the CFIM group. Further, the number of patients who suffered from postoperative nausea was significantly lower in the VFIM group than in the CFIM group until six hours after surgery. The variable-rate feedback infusion mode of patient-controlled epidural analgesia may provide better analgesia accompanied with significantly less nausea in the early postoperative period than the conventional fixed-rate basal infusion mode following open gastrectomy.
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Affiliation(s)
- Yoo Kyung Jang
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Korea; (Y.K.J.); (H.G.K.); (S.W.L.)
| | - Na Young Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (N.Y.K.); (J.S.L.)
| | - Jeong Soo Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (N.Y.K.); (J.S.L.)
| | - Hye Jung Shin
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea;
| | - Hyoung Gyun Kim
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Korea; (Y.K.J.); (H.G.K.); (S.W.L.)
| | - Suk Woo Lee
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Korea; (Y.K.J.); (H.G.K.); (S.W.L.)
| | - Jae Chul Koh
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Korea; (Y.K.J.); (H.G.K.); (S.W.L.)
- Correspondence: (J.C.K.); (Y.C.Y.); Tel.: +82-920-5632 (J.C.K.); +82-2228-4435 (Y.C.Y.)
| | - Young Chul Yoo
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (N.Y.K.); (J.S.L.)
- Correspondence: (J.C.K.); (Y.C.Y.); Tel.: +82-920-5632 (J.C.K.); +82-2228-4435 (Y.C.Y.)
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Gathege D, Abdulkarim A, Odaba D, Mugambi S. Effectiveness of Pain Control of Local Anaesthetic Wound Infusion Following Elective Midline Laparotomy: A Randomized Trial. World J Surg 2021; 45:2100-2107. [PMID: 33763741 DOI: 10.1007/s00268-021-06072-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Post-operative pain control is an important pillar in enhanced recovery after surgery. There is a paucity of data that compares efficacy of pain control between continuous local anaesthetic wound infusion and thoracic epidural analgesia in elective midline laparotomy patients OBJECTIVE: To evaluate pain control between continuous local anaesthetic wound infusion and thoracic epidural analgesia in elective laparotomy patients. DESIGN A randomized, single-blind, controlled clinical trial. SETTING Aga Khan University Hospital, Nairobi, Kenya. POPULATION Patients underwent elective laparotomy. METHODS Thirty-eight patients scheduled for elective laparotomy were randomized into two equal groups to receive either continuous local anaesthetic wound infusion or thoracic epidural analgesia. Data on the baseline patient characteristics, total morphine consumption at 72 h, visual analogue scores and rates of adverse effects were collected. RESULTS Baseline characteristics of the participants were similar. Continuous local anaesthetic wound infusion was equivalent to thoracic epidural analgesia in terms of pain scores and total morphine consumption at 72 h. Duration of hospital stay was shorter in the intervention arm. There were more surgical site infections in the intervention arm, while catheter dislodgement rate was higher in the thoracic epidural arm. CONCLUSION Continuous local anaesthetic wound infusion is equivalent to thoracic epidural analgesia in management of post-operative pain following elective midline laparotomy. CLINICAL TRIAL REGISTRATION Pan African Clinical Trial registry, number PACTR201808607220790.
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Affiliation(s)
| | | | - David Odaba
- Aga Khan University Hospital, Nairobi, Kenya
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Li TT, Xiong LL, Huang J, Wen S, Chen YJ, Wang TH, Liu F. The Effects of Body Mass Index on the Use of Patient-Controlled Intravenous Analgesia After Open Gastrointestinal Tumor Surgery: A Retrospective Analysis. J Pain Res 2020; 13:2673-2684. [PMID: 33116809 PMCID: PMC7588277 DOI: 10.2147/jpr.s261997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/28/2020] [Indexed: 02/05/2023] Open
Abstract
Purpose To investigate the impact of body mass index (BMI) on the analgesic effects and adverse reactions of patient-controlled intravenous analgesia (PCIA). Methods From 2017 to 2018, 390 patients undergoing open gastrointestinal surgery were reviewed at West China Hospital, Sichuan University. All used PCIA of sufentanil combined with dexmedetomidine and flurbiprofen axetil. According to their BMIs, they were placed into six groups: group A (BMI < 18.5kg/m2, 29), group B (18.5kg/m2 ≤ BMI< 22kg/m2, 124), group C (22kg/m2 ≤ BMI < 24kg/m2, 99), group D (24kg/m2 ≤ BMI < 26kg/m2, 69), group E (26kg/m2 ≤ BMI < 28kg/m2, 46) and group F (BMI ≥28kg/m2, 23). Main data of the perioperative use of analgesics, postoperative visual analogue score (VAS), and adverse reactions were collected. Results Twenty-four hours (h) after surgery, patients in group A had a higher resting VAS than the other groups, especially B (pA-B = 0.011). VAS of patients during activity in group B was lower than those in group C 48 h after surgery (p = 0.013). Compared with groups B to F, group A had a significantly lower incidence of hypertension (p = 0.012) and a significantly higher incidence of vomiting 24 h after surgery (p = 0.009). Binary logistic analysis found that higher age was a risk factor for vomiting 24 h after surgery (OR 1.158, p = 0.045). Conclusion Using the same PCIA, patients with BMIs of less than 18.5 kg/m2 had worse analgesia on the first day after surgery and were more likely to vomit. Postoperative analgesia and related experiences in patients with BMIs of less than 18.5 kg/m2 need to be improved.
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Affiliation(s)
- Ting-Ting Li
- Department of Anesthesiology, Institute of Neurological Disease, West China Hospital, Sichuan University, Chengdu, 610044, People's Republic of China
| | - Liu-Lin Xiong
- School of Pharmacy and Medical Sciences, Faculty of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Jin Huang
- Laboratory Zoology Department, Institute of Neuroscience, Kunming Medical University, Kunming, People's Republic of China
| | - Song Wen
- Department of Pain, Affiliated Hospital of Zunyi Medical University, Guizhou, People's Republic of China
| | - Yan-Jun Chen
- Department of Anesthesiology, Institute of Neurological Disease, West China Hospital, Sichuan University, Chengdu, 610044, People's Republic of China
| | - Ting-Hua Wang
- Department of Anesthesiology, Institute of Neurological Disease, West China Hospital, Sichuan University, Chengdu, 610044, People's Republic of China
| | - Fei Liu
- Department of Anesthesiology, Institute of Neurological Disease, West China Hospital, Sichuan University, Chengdu, 610044, People's Republic of China
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Wang L, Liang S, Chen H, Xu Y, Wang Y. The effects of epidural anaesthesia and analgesia on T lymphocytes differentiation markers and cytokines in patients after gastric cancer resection. BMC Anesthesiol 2019; 19:102. [PMID: 31185917 PMCID: PMC6560762 DOI: 10.1186/s12871-019-0778-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/05/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Epidural use can prevent peri-operative neuro-endocrine stress responses, mitigate pain after surgery, and reduce opioid use, which all lead to immunosuppression. METHODS Forty patients with gastric cancer were ultimately enrolled into the study. Patients who received general anaesthesia (GA group, n = 20) or a combination of general anaesthesia and peri-operative epidural use (EGA group, n = 20) were given intravenous analgesia or epidural analgesia, respectively. We collected visual analogue scale (VAS) scores, length of hospital stay, the time of the first passage of flatus and incidence of postoperative nausea and vomiting (PONV). We also collected data on the cluster of differentiation markers (CD)3+, CD4+, CD8+, CD4+/CD8+, interleukin (IL)-4, IL-6, and interferon (IFN)-γ the day before surgery as well as on postoperative days 1, 3, and 7. RESULTS VAS scores and PONV in the GA group were higher than in the EGA group on postoperative day 3. CD3+, CD4+, and CD4+/CD8+ T cells declined on postoperative day 3 and nearly recovered to baseline seven days after surgery in both groups. CD3+ T cells decreased more in the GA group than in the EGA group. IL-4, IL-6, and IFN-γ increased on postoperative day 3 and nearly recovered to baseline seven days after surgery in both groups. IL-4 and IL-6 increased more in the GA group than in the EGA group. IFN-γ increased more in the EGA group than in the GA group. CONCLUSIONS A combination of general anaesthesia and peri-operative epidural use can relieve postoperative pain and PONV. A combination of general anaesthesia and peri-operative epidural use decreases immunosuppression in gastric cancer resection. TRIAL REGISTRATION The study procedures were approved by the Ethics Committee of The Harbin Medical University Cancer Hospital. This study was registered prospectively at http://www.chictr.org.cn/index.aspx on October 10, 2017 (Registered ChiCTR-INR-17012939 ).
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Affiliation(s)
- Liping Wang
- Department of Anaesthesiology, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Si Liang
- Department of Anaesthesiology, Affiliated Hospital of HeBei University, Baoding, China
| | - Hong Chen
- Department of Anaesthesiology, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Yang Xu
- Department of Anaesthesiology, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Yu Wang
- Department of Anaesthesiology, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China.
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Baar W, Goebel U, Buerkle H, Jaenigen B, Kaufmann K, Heinrich S. Lower rate of delayed graft function is observed when epidural analgesia for living donor nephrectomy is administered. BMC Anesthesiol 2019; 19:38. [PMID: 30885139 PMCID: PMC6421667 DOI: 10.1186/s12871-019-0713-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/11/2019] [Indexed: 12/14/2022] Open
Abstract
Background The beneficial effects of epidural analgesia (EDA) in terms of pain control and postoperative convalescence are widely known and led to a frequent use for patients who underwent living donor kidney nephrectomy. The objective of this study was to determine whether general anesthesia (GA) plus EDA compared to GA only, administered for living donor nephrectomy has effects on postoperative graft function in recipients. Methods In this monocentric, retrospective cohort analysis we analyzed the closed files of all consecutive donor- recipient pairs who underwent living donor kidney transplantations from 2008 to 2017. The outcome variable was delayed graft function (DGF), defined as at least one hemodialysis within seven days postoperatively, once hyperacute rejection, vascular or urinary tract complications were ruled out. Statistical analyses of continuous variables were calculated using the two-tail Student’s t test and Fisher exact test for categorical variables with a significance level of p < 0.05, respectively. Results The study enclosed 291 consecutive living donor kidney transplantations. 99 kidney donors received epidural analgesia whereas 192 had no epidural analgesia. The groups showed balanced pretransplantational characteristics and comparable donors´ and recipients’ risk factors. 9 out of all 291 recipients needed renal replacement therapy (RRT) during the first 7 days due to delayed graft function; none of these donors received EDA. The observed rate of DGF in recipients whose kidney donors received epidural analgesia was significantly lower (0% vs. 4.6%; p = 0.031). Conclusions In our cohort we observed a significantly lower rate of DGF when epidural analgesia for donor nephrectomy was administered. Due to restrictions of the study design this observation needs further confirmation by prospective studies.
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Affiliation(s)
- Wolfgang Baar
- Department of Anesthesiology and Critical Care, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Ulrich Goebel
- Department of Anesthesiology and Critical Care, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Hartmut Buerkle
- Department of Anesthesiology and Critical Care, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Bernd Jaenigen
- Department of General and Visceral Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Kai Kaufmann
- Department of Anesthesiology and Critical Care, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Sebastian Heinrich
- Department of Anesthesiology and Critical Care, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
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