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A Novel Technique of Paravertebral Thoracic and Preperitoneal Analgesia Enhances Early Recovery After Oesophagectomy

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Abstract

Background

Excellent analgesia following oesophagectomy facilitates patient comfort, early extubation, physiotherapy and mobilisation, reduces post-operative complications and should enhance recovery. Thoracic epidural analgesia (TEA), the gold standard analgesic regimen for this procedure, is often associated with systemic hypotension treated with inotropes or fluid. This may compromise enhanced recovery and be complicated by anastomotic ischaemia or tissue oedema.

Methods

We report a novel analgesic regimen to reduce post-operative inotrope usage. Infusion of ropivicaine via bilateral preperitoneal and right paravertebral catheters was used. Patient-controlled epidural pethidine provided rescue analgesia (WC) (n = 21). A retrospective audit of inotrope requirement, mean pain scores, episodes of respiratory depression and excessive sedation, need for reintubation, reoperation in the first 5 post-operative days, time to mobilisation, time in intensive care, time in hospital and 30-day mortality were measured. These results were compared with those of an earlier patient group who received a thoracic epidural infusion of low-dose local anaesthetic and fentanyl (TEA) (n = 21).

Results

Inotrope use was reduced by 29% in the WC group (p = 0.03) and the mean intensive care stay reduced by 2.4 days (p = 0.03), as was reintubation rate (p = 0.01) and early mobilisation (p = 0.03). The pain score was comparable in both groups, and there was no difference in the other outcomes examined.

Conclusion

The data demonstrated that it was possible to provide excellent post-oesophagectomy analgesia equivalent to thoracic epidural infusions of local anaesthetic with reduction in inotrope requirements, intensive care stay, more rapid mobilisation, facilitating enhanced recovery.

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Authors and Affiliations

  1. Sydney Adventist Hospital, Wahroonga, Sydney, Australia

    Stephanie Phillips & Jasmina Dedic-Hagan

  2. University of Sydney, Sydney, Australia

    Stephanie Phillips & G. L. Falk

  3. Sydney Medical School, University of Sydney, Sydney, Australia

    d’Arcy Ferris Baxter

  4. Concord Nuclear Imaging, Sydney, Australia

    H. Van der Wall

  5. Macquarie University, Sydney, Australia

    G. L. Falk

  6. Suite 29, 12 Tryon Road, Lindfield, NSW, 2070, Australia

    G. L. Falk

Authors
  1. Stephanie Phillips
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  2. Jasmina Dedic-Hagan
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  3. d’Arcy Ferris Baxter
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  4. H. Van der Wall
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  5. G. L. Falk
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Corresponding author

Correspondence to G. L. Falk.

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Phillips, S., Dedic-Hagan, J., Baxter, d.F. et al. A Novel Technique of Paravertebral Thoracic and Preperitoneal Analgesia Enhances Early Recovery After Oesophagectomy. World J Surg 42, 1787–1791 (2018). https://doi.org/10.1007/s00268-017-4369-9

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  • DOI: https://doi.org/10.1007/s00268-017-4369-9

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