Comparative study between thoracic epidural anaesthesia and general anaesthesia in open cholecystectomy

International Journal of Medical Science
© 2017 by SSRG - IJMS Journal
Volume 4 Issue 11
Year of Publication : 2017
Authors : Dr.Tushar H. Majumder, Dr.Partha deb-barma, Dr.Biswajit sutradhar and Dr.H.Shanti singh
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Dr.Tushar H. Majumder, Dr.Partha deb-barma, Dr.Biswajit sutradhar and Dr.H.Shanti singh, "Comparative study between thoracic epidural anaesthesia and general anaesthesia in open cholecystectomy," SSRG International Journal of Medical Science, vol. 4,  no. 11, pp. 1-5, 2017. Crossref, https://doi.org/0.14445/23939117/IJMS-V4I11P101

Abstract:

Objective: To compare the quality of anaesthesia heamodynamic stability, postoperative pain relief and vomiting and the length of hospital stay in patients undergoing open cholecystectomy under general anaesthesia versus those receiving thoracic epidural anaesthesia. Study Design: Quasi experimental study. Place and Duration of Study-Agartala medical college and GBP hospital.Study duration july1016 to june 2017. Methodology: One hundred of American Society of Anaesthesiology (ASA) physical status (PS) I and II patients of either gender undergoing un-complicated open cholecystectomy were randomly divided into two groups, group 1 (n=50) received general anaesthesia (GA) and group 2 (n=50) received thoracic epidural anaesthesia (EA). Patients of both the groups were assessed for quality of anaesthesia, postoperative pain, vomiting and length of hospital stay. Chi-square test was applied to compare the two groups and obtain the p-value. P-value of less than 0.05 was considered significant. Results: Quality of anaesthesia in both group are good. Heamodynamic sability was better maintain with epidural group. Thirty five patients of GA group did not require additional analgesics for postoperative pain relief; however, injection paracetamol 15mg/kg had to be administered to 15 patients (30%) for pain relief in the postoperative period. Two patients (4%) in the EA group required additional analgesic during that period. Eleven patients (22%) in the GA group had post-operative vomiting. In the EA group only 1 patient (2%) had postoperative vomiting. Patients in EA group had better post-operative pain relief (p = 0.001) and remained free from vomiting than the GA group (p = 0.003). Thirty five patients (70%) of the GA group and 35 patients (70%) in the EA group were discharged within 36 hours postoperatively (p = 0.896). Conclusion: The use of intra-operative epidural anaesthesia combined with postoperative epidural analgesia was found to be associated with better heamodynmic stability, reduction in the postoperative pain and vomiting in patients undergoing open cholecystectomy.

Keywords:

Epidural anaesthesia, epidural anaesthesia, PONV, heamodynamic data, open cholecystectomy.

References:

[1] Bablekos GD, Michaelides SA, Roussou T, Charalabopoulos KA. Changes in breathing control and mechanics after laparoscopic vs. open cholecystectomy. Arch Surg 2006; 141:16-22. 
[2] Gunnarsson L, Lindberg P, Tokics L, Thorstensson O, Thörne A. Lung function after open versus laparoscopic cholecystectomy. Acta Anaesthesiol Scand 1995; 39:302-6. 
[3] Ballantyne JC, Carr DB, deFerranti S, Suarez T, Lau J, Chalmers TC, et al. The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta- analyses of randomized, controlled trials. Anesth Analg 1998; 86:598-612. 
[4] Holte K, Kehlet H. Effect of postoperative epidural analgesia on surgical outcome. Br J Anaesth 2001; 87:62-72. 
[5] Grass JA. The role of epiduralAnesthesiolanaesthesiaClinNorth Americaandnalgesia in postoperative outcome. 2000; 18: 407-28, viii.
[6] Liu S, Carpenter RL, Neal JM. Epidural anaesthesia and analgesia.Anaesthesia 1995; 82:1474-506.
[7] Park WY, Thompson JS, Lee KK. Effect of epidural anaesthesia and analgesia on peri-operative outcome. A randomized, controlled Veterans affairs co-operative study. Ann Surg 2001; 234:560-9; discussion 569-71. 
[8] Groban L, Zvara DA, Deal DD, Vernon JC, Carpenter RL. Thoracic epidural anaesthesia reduce s infarct size in canine model  of  myocardial  ischemia  and  re-perfusion  injury. J Cardiothorac Vasc Anesth 1999; 13:579-85. 
[9] Yeager MP, Glass DD, Neff RK, Brinck-Johnsen T. Epidural anaesthesia and analgesia in high risk surgical patients. Anesthesiology,1987,66:729-36
[10] Rosenfeld et el, The effects of different anaesthetic regimens on DVT, 1993;435-43.
[11] Ballantyne JC et al, The comparative effects of postoperative analgesia therapies on pulmonary outcome, anaesthesia analgesia1998;86:598-612.
[12] Steinbrook RA. Epidural anaesthesia and gastrointestinal motility. Anesth Analg 1998; 86:837-44 
[13] Procopio MA, Rassias AJ, DeLeo JA, Pahl J, Hildebrandt L, Yeager  MP.  The  in  vivo  effects  of  general  and  epidural anaesthesia on human immune function. Anesth Analg 2001; 93:460-5 
[14] Rigg JR, Jamrozik K, Myles PS, Silbert BS, Peyton PJ, Parsons RW, et al. Epidural anaesthesia and analgesia and outcome of major surgery: a randomized trial. Lancet 2002; 359:1276-82. 
[15] Rosenquist RW, Brown DL. Incorporating regional anaesthesia into anaesthetic practice. In: Longnecker DE, editor. Anaesthesiology. New York: McGraw-Hill; 2008. p. 974-7. 
[16] Viscusi ER. Emerging techniques in the management of acute pain: epidural analgesia. Anesth Analg  2004; 101:S23-9. 
[17] Beattie WS, Buckley DN, Forrest JB. Epidural morphine reduces the risk or postoperative myocardial ischemia in patients with cardiac risk factors. Can J Anaesth 1993; 40: 532-541. 
[18] de Leon-Casasola OA, Lema MJ, Karabella D, Harrison P. Postoperative myocardial ischemia: epidural versus intravenous patient-controlled analgesia. A pilot project. Reg Anesth 1995; 20:105-12. 
[19] Carli F, Mayo N, Klubien K, Schricker T, Trudel J, Belliveau P. Epidural analgesia enhances functional exercise capacity and health-related quality of life after colonic surgery: results of a randomized trial. Anesthesiology 2002; 97:540-9. 
[20] Bradshaw BG, Lui SS, Thirlby RC. Standardized perioperative care protocols and reduced length of stay after colon surgery. J Am Coll Surg 1998; 186:501-6. 
[21] Buggy DL, Smith G. Editorial. Epidural anaesthesia and analgesia: better outcome after major surgery? Growing evidence suggest so. BMJ 1999; 319:530-1. 
[22] Johnstone RE, Martinec CL. Costs of anaesthesia. Anesth Analg 1993; 76:840-8. 
[23] Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomized trials. Br Med J 2000; 321:1493. 
[24] Moraca RJ, Sheldon DG, Thirlby RC. The role of epidural anaesthesia and analgesia in surgical practice. Ann Surg 2003; 238:663-73.
[25] Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg 2002; 183:630-41