Impact of Thoracic Epidural Analgesia on Major Adverse Cardiac Events (Maces) Following Major Gastrointestinal Cancer Surgeries

Background and Objectives: Major gastrointestinal cancer surgeries are associated with significant perioperative mortality and morbidity due to increased incidence of major perioperative cardiovascular event (MACEs). This study examined the effect of perioperative patient controlled epidural analgesia (PCEA) on reduction of MACEs in cardiac risky patients undergoing major gastrointestinal cancer surgery.

Methods: 60 patients (ASA II and III) of either sex were scheduled for elective Upper gastrointestinal cancer surgeries. Patients were allocated randomly into two groups (30 patients each) to receive, beside GA: continuous intra and post -operative intravenous infusion with fentanyl for 72 hours post-operatively (control group) or continuous intra and post -operative epidural infusion with bupivacaine 0.125% and fentanyl (TEA group) for 72 hours post-operatively
Intra-operative and post operative (HR and MAP) were recorded. Postoperative pain was assessed over 72 h using numerical rating scale (NRS). All patients were screened for occurrence of MACEs by ECG and echocardiography. And other postoperative complications and duration of ICU stay were recorded.

Results: There was a significant decrease in the incidence of MACEs with less pain scores in patients of TEA group in comparison to control group. Postoperative complications were comparable in both groups.

Conclusion: Perioperative PCEA in cardiac risky patients subjected to major gastrointestinal cancer surgery reduced significantly postoperative major adverse cardiac events with better pain control in comparison with perioperative PCIA analgesia.

Keywords: major perioperative cardiovascular event (MACEs), thoracic epidural analgesia, PCA, NRS.