Epidural analgesia after minimally invasive esophagectomy: efficacy and complication profile

Kingma, B.F. (2017) Epidural analgesia after minimally invasive esophagectomy: efficacy and complication profile. thesis, Medicine.

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Abstract

INTRODUCTION Effective pain management is essential for patient comfort, early recovery, low surgical morbidity and short hospitalization after esophagectomy. Although epidural analgesia is currently the gold standard for pain control, this modality can be problematic due to technical failure or epidural related complications. AIM The aim of this study was to describe the adequacy of pain control and complications of epidural analgesia after minimally invasive esophagectomy. METHODS A prospective database (2012-2015) was used to select all patients that underwent robot-assisted transthoracic minimally invasive esophagectomy for cancer. The number of patients that can receive epidural analgesia, the adequacy of sensory block, the number of top-up procedures, the need for (additional) parenteral systemic opioids, the highest pain score per day (in NRS), and epidural related complications were assessed until postoperative day 4. RESULTS A total of 108 patients were included. An epidural catheter was placed in 101 patients (94%). In the patients that received epidural analgesia, the adequacy of block was 49%, 42%, 20%, and 30% on postoperative days 1, 2, 3, and 4. The epidural was topped up in 26 patients (25%), which had at least a temporary effect in 22 of these patients (85%). Parenteral systemic opioids were given in 49 out of 108 patients (45%) on postoperative days 1, 2, 3, and/or 4. Median highest pain scores on the corresponding days were 2.0, 4.0, 3.0, and 4.0. Complications related to epidural analgesia were encountered in 19 patients (19%); catheter problems (n=10), hypotension (n=6), bradypnea (n=2), and reversible tingling in the legs (n=1). CONCLUSION This study demonstrates that an epidural catheter can be placed in the vast majority of patients. However, nearly half of the patients have a need for (additional) parenteral systemic opioids. These results indicate that pain management after minimally invasive esophagectomy can be improved and that alternative modalities have to be investigated.

Item Type:	Thesis (Thesis)
Supervisor name:	First supervisor: and Keller, dr. B.P.J.A. surgeon
Supervisor name:	Second supervisor: and Visser, drs. E. PhD candidate / and Hillegersberg, prof. dr. R. Van surgeon and Location: Department of Gastro-intestinal Surgical Oncology
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:02
Last Modified:	25 Jun 2020 11:02
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2201

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