Mahmut ARSLAN, Gozen OKSUZ

Effects of thoracic epidural analgesia on postoperative pulmonary complications aftermajor abdominal surgery

The incidence of postoperative pulmonary complications (PPC) has been reported to be 5-40% following major abdominal surgery. Thoracic epidural analgesia (TEA) reduces PPC. The aim of this study was to determine the incidence of PPC and to assess the effect of TEA on PPC in patients who underwent major abdominal surgery in a tertiary university hospital. The files of patients who underwent major abdominal surgery between January 2016 and December 2017 were reviewed retrospectively. The patients were divided into general anesthesia (group 1) and general anesthesia with TEA (group 2) groups. Patient demographic data, smoking history, COPD (Chronic obstructive pulmonary disease) history, diagnosis, surgical process, type of surgery (open / laparoscopic), duration of surgery and PPC at 7 days were recorded. A total of 52 patients’ records were reviewed. PPC occurred in 11 patients in group 1 and in 5 patients in group 2. There was no statistically significant difference between groups in terms of PPC (p = 0.496). The most common PPC was atelectasis (Group 1: 7,Group 2: 5). Weak correlation was found between development of PPC and duration of surgery (r: 0,391, p = 0.004). We found 30% incidence of PPC in our institution in this study. We could not demonstrate a significant reduction in the incidence of PPC with TEA.

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1. Patel K, Hadian F, Ali A, et al. Postoperative pulmonary complications following major elective abdominal surgery: a cohort study. Perioperative Med. 2016;5:10.

2. Khuri SF, Henderson WG, DePalma RG, et al. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005;242:326-41

3. Dimick JB, Chen SL, Taheri PA, et al. Hospital costs associated with surgical complications: a report from the private-sector National Surgical Quality Improvement Program. J Am Coll Surg. 2004;199:531-7.

4. Warner DO. Preventing postoperative pulmonary complications: the role of the anesthesiologist. Anesthesiol. 2000; 92:1467-72.

5. Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology 2010;113:1338-50.

6. Ballantyne J, Carr D, deFerranti S. The comparative effects of postoperative analgesic therapies on pulmonary outcome: Cumulative meta-analyses of randomized, controlled trials. Anesthesia and Analgesia 1998;86:598-612.

7. Moraca R, Sheldon D ,Thirlby R. The role of epidural anesthesia and analgesia in surgical practice. Ann Surg. 2003;238:663-73.

8. Jammer I, Wickboldt N, Sander M, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions. Eur J Anaesthesiol. 2015;32:88-105.

9. Hedenstierna G, Edmark L. The effects of anesthesia and muscle paralysis on the respiratory system. Intensive Care Med. 2005;31:1327-35.

10. Hans GA, Sottiaux TM, Lamy ML, et al. Ventilatory management during routine general anaesthesia. Eur J Anaesthesiol. 2009;26:1-8.

11. Popping DM, Elia N, Marret E, et al. Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery: a meta-analysis. Arch Surg. 2008;143:990-9.

12. Rigg JR, Jamrozik K, Myles PS, et al. Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet. 2002;359:1276-82.

13. Nishimori M, Low J, Zheng H, et al. Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery. Cochrane Database Syst Rev. 2012;7:CD00505.

14. Park W, Thompson J, Lee K. Effect of epidural anesthesia and analgesia on perioperative outcome: a randomized, controlled veterans affairs cooperative study. Ann Surg. 2001;234:560-71.

15. Amini N, Kim Y, Hyder O, et al. A nationwide analysis of the use and outcomes of perioperative epidural analgesia in patients undergoing hepatic and pancreatic surgery. Am J Surg. 2015;210:483-91.

16. Lee CZ, Kao LT, Lin HC, Wei PL. Comparison of clinical out- come between laparoscopic and open right hemicolectomy: a nationwide study. World J Surg Oncol. 2015;13:250.

17. Jiang L, Yang KH, Guan QL, et al. Laparoscopy-assisted gastrectomy versus open gastrectomy for resectable gastric cancer: an update meta-analysis based on randomised con- trolled trials. Surg Endosc. 2013;27:2466-80.