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Annals of Surgical Oncology

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01-05-2014 | Original Article -– Regional Cancer Therapies

Safety of Epidural Analgesia in the Perioperative Care of Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

Authors: Pascal Owusu-Agyemang, MD, Jose Soliz, MD, Andrea Hayes-Jordan, MD, Nusrat Harun, Vijaya Gottumukkala, MD

Published in: Annals of Surgical Oncology | Issue 5/2014

Abstract

Background

The perioperative coagulopathy, hemodynamic instability, and infectious complications that may occur during cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has raised concerns about the safety of epidural analgesia in patients undergoing such procedures.

Methods

We conducted a retrospective review of the perioperative anesthetic management of 215 adult patients who had undergone CRS with HIPEC with epidural analgesia. We reviewed epidural-related complications and analyzed the effect of early initiation of continuous epidural analgesia on estimated blood loss, intraoperative fluid administration, blood transfusion and vasopressor requirements, time to extubation, and length of stay.

Results

No epidural hematomas or abscesses were reported. Two patients (0.9 %) had delays in epidural removal because of thrombocytopenia, and two had epidural-site erythema (0.9 %). The majority of postoperative epidural-related hypotensive episodes were successfully treated with fluid boluses. Early initiation of epidural analgesic infusions (before HIPEC) was associated with significantly less surgical blood loss and fluid requirements (P = 0.005 and 0.02, respectively). Pre-HIPEC initiation of epidural infusions was not associated with a statistically significant difference in the following: volume of blood transfused, intraoperative vasopressors use, time to extubation, and length of hospital stay.

Conclusions

With close hematologic monitoring and particular attention to sterility, epidural analgesia can be safely provided to patients undergoing CRS with HIPEC. Early initiation of continuous epidural infusions during surgery could lead to decreased blood loss and less intraoperative fluid administration. Prospective randomized studies are required to further investigate these potential benefits.

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Title: Safety of Epidural Analgesia in the Perioperative Care of Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy
Authors: Pascal Owusu-Agyemang, MD
Jose Soliz, MD
Andrea Hayes-Jordan, MD
Nusrat Harun
Vijaya Gottumukkala, MD
Publication date: 01-05-2014
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 5/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-013-3221-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Safety of Epidural Analgesia in the Perioperative Care of Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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