Epidural anesthesia dysfunction is associated with postoperative complications after pancreatectomy. (20th January 2016)

• Record Type: Journal Article
• Authors: Sugimoto, Motokazu; Nesbit, Lauren; Barton, Joshua G.; William Traverso, L.
• Is Part Of: Journal of hepato-biliary-pancreatic sciences. Volume 23:Number 2(2016)
• Page Start: 102
• Page End: 109
• Publication Date: 2016-01-20
• Subjects: Epidural analgesia -- Epidural anesthesia -- Pancreatectomy -- Postoperative complication; Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 617.556
• DOI: 10.1002/jhbp.307
• Languages: English
• ISSNs: 1868-6974

Abstract

Abstract: Background: Epidural anesthesia is an accepted measure of pain control after major abdominal surgery. However, if the epidural anesthesia is unsuccessful, a variety of adverse effects can occur – excessive stress response, poor patient mobilization, increased opioid use, and hypotension due to vasodilation. The aim of this study was to evaluate the influence of epidural dysfunction on outcomes after pan‐createctomy. Methods: Between August 2010 and October 2014, 72 patients underwent open pancreatectomy with epidural anesthesia. Epidural dysfunction was defined as either hypo‐function due to inadequate pain control (requirement of epidural replacement, conversion to intravenous continuous opioid infusion, or intravenous bolus opioid use) or hyper‐function (hypotension or oliguria). We then analyzed for an association between epidural dysfunction and surgical outcomes. Results: Epidural dysfunction occurred in 49% after pancreatectomy – hypo‐function in 35% and hyper‐function in 14%. Epidural dysfunction was independently associated with the development of overall ( P < 0.001), pancreas‐related ( P = 0.041), and non‐pancreas‐related complications ( P = 0.001). Hypo‐function alone was independently associated with both pancreas‐related ( P = 0.015) and non‐pancreas‐related complications ( P = 0.004). Hyper‐function was independently associated with non‐pancreas‐related complications ( P = 0.002). Conclusions: Outcomes after pancreatic resection can be improved by increasing the success rate of epidural anesthesia. Abstract : Highlight With the aim to assess the impact of epidural anesthesia dysfunction on outcomes after pancreatectomy, Sugimoto and colleagues revealed an independent association between hypo‐function and both pancreas‐related and non‐pancreas‐related complications, and between hyper‐function and non‐pancreas‐related complications. Increasing the success rate of epidural anesthesia is key to improve outcomes after pancreatectomy.