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Thoracic Epidural Anaesthesia for Upper Abdominal Surgery
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Background: Thoracic epidural anaesthesia (TEA) has many benefits over general anaesthesia in major abdominal surgeries including avoidance of endo tracheal intubation. Aims: To evaluate the feasibility of TEA for various upper abdominal surgeries using 0.5% bupivacaine. Patients and Methods: This was a clinical study of 50 selected patients undergoing elective upper abdominal surgery under TEA conducted at hospitals attached to JJM Medical college Davangere for a period of 3 years. All thoracic epidural anaesthesia was performed under aseptic conditions at T 8/9 interspinous space using a size 18G Tuohy needle and catheter inserted at appropriate level. A test dose of 3 ml 2% lignocaine with adrenaline was used in all patients ,after which a single dose of 10 ml 0.5% bupivacaine was injected steadly at a rate 0.5 ml per sec. The operative conditions was assessed on basis of sedation and analgesia requirement, as well as response to mesentric traction. Surgeons opinion with regard to muscle relaxation was taken. The pulse rate, blood pressure and oxygen saturation were monitored throughout the procedure and recorded. Information obtained included age, gender, ASA status, diagnosis and type of surgery performed. Data analysis was performed under guidance of statician. Results: 50 patients under went major abdominal surgeries. The mean age was 35.3 +_ 9.4 yrs (20-50), with male to female ratio of 1:1. Onset of analgesia was of 17.4 +_2.1 min (15-22), 88% of patients had Grade 1 analgesia, 68% of patients had good muscle relaxation, hemodynamic changes was significant with 6 patients having bradycardia and was treated with Ing atropine. Conclusion: Thoracic epidural anaesthesia for upper abdominal surgeries provide good analgesia and muscle relaxation with minimal amount of drug used . Hemodynamic changes are significant. Post operative complications were minimal and was managed satisfactorily
Perspectives
Background: Thoracic epidural anaesthesia (TEA) has many benefits over general anaesthesia in major abdominal surgeries including avoidance of endo tracheal intubation. Aims: To evaluate the feasibility of TEA for various upper abdominal surgeries using 0.5% bupivacaine. Patients and Methods: This was a clinical study of 50 selected patients undergoing elective upper abdominal surgery under TEA conducted at hospitals attached to JJM Medical college Davangere for a period of 3 years. All thoracic epidural anaesthesia was performed under aseptic conditions at T 8/9 interspinous space using a size 18G Tuohy needle and catheter inserted at appropriate level. A test dose of 3 ml 2% lignocaine with adrenaline was used in all patients ,after which a single dose of 10 ml 0.5% bupivacaine was injected steadly at a rate 0.5 ml per sec. The operative conditions was assessed on basis of sedation and analgesia requirement, as well as response to mesentric traction. Surgeons opinion with regard to muscle relaxation was taken. The pulse rate, blood pressure and oxygen saturation were monitored throughout the procedure and recorded. Information obtained included age, gender, ASA status, diagnosis and type of surgery performed. Data analysis was performed under guidance of statician. Results: 50 patients under went major abdominal surgeries. The mean age was 35.3 +_ 9.4 yrs (20-50), with male to female ratio of 1:1. Onset of analgesia was of 17.4 +_2.1 min (15-22), 88% of patients had Grade 1 analgesia, 68% of patients had good muscle relaxation, hemodynamic changes was significant with 6 patients having bradycardia and was treated with Ing atropine. Conclusion: Thoracic epidural anaesthesia for upper abdominal surgeries provide good analgesia and muscle relaxation with minimal amount of drug used . Hemodynamic changes are significant. Post operative complications were minimal and was managed satisfactorily
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This page is a summary of: Thoracic Epidural Anaesthesia for Upper Abdominal Surgery, Indian Journal of Anaesthesia and Analgesia, September 2020, Red Flower Publication Private, Ltd.,
DOI: 10.21088/ijaa.2349.8471.7520.33.
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