Volume 7 Issue 11 (November, 2019)

Original Articles

Combined Thoracic Epidural with General Anesthesia Vs General Anesthesia Alone for Major Abdominal Surgery- Anesthetic Requirements and Stress Response
Akansha Sharma, Ambareen Momin, Kunal Raj Talreja

Background: Epidural analgesia (EA) is a key adjuvant therapy for effective postoperative pain control after abdominal surgery. Major surgery induces profound physiological changes in the perioperative period, characterised by increases in sympathoadrenal and other neuroendocrine activity and also increased cytokine production. Because epidural anaesthesia can attenuate this “stress response” to surgery, improve the quality of postoperative analgesia in comparison with systemic opioids, and hasten recovery of gut function, it has been suggested that conducting surgery under epidural anaesthesia (either as the sole anaesthetic or in combination with general anaesthesia) may reduce perioperative morbidity and mortality compared with general anaesthesia alone. Aim of the study: To evaluate the effect of General anaesthesia with epidural analgesia(EA-GA) use vs General anaesthesia for major abdominal surgeries. Materials and methods: The study was conducted in the Department of Anesthesiology of the Medical Institution. For the study, a total of 60 patients of both genders scheduled for major abdominal surgeries with age ranging between 18-75 years were included in the study. Patients with metabolic diseases, drug abuse, severe cardiovascular diseases, and having contraindications to neuraxial blockade as hypersensitivity were excluded from the study. The patients were randomly equally grouped into two groups, Group 1 and Group 2. Patients in group 1 received combined general anesthesiawith thoracic epidural as maintenance anesthesia. Patients in group 2 received only general anesthesiaas maintenance anesthesia. All patients received Tab alprazolam 0.5mg and Tab ranitidine 150 mg on prior night of the surgery. Patients was kept nil by mouth from midnight.Results: A total of 60 patients were included in the study and were randomly grouped equally into Group 1 and Group 2. The mean age in group 1 was 60.25 years and in group 2 was 63.25 years. Mean duration of operation in Group 1 was 152.32 min and in Group 2 was 180.33 min. We observed that both groups show similar pattern with respect to arterial blood pressure changes. Heart rate showed significant higher values compared to baseline after induction, pre and post intubation and at skin incision in both studied groups. Heart rate showed persistently increased lower values in group 1 as compared to group 2. Conclusion: From the results of present study, this can be concluded that combined general and thoracic epidural block decreases stress response more than general anesthesia alone during major abdominal surgery. Key words: Analgesia, general anesthesia, abdominal surgery

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