Mohamad Mohamad Farouk, Mohammad Montaser A, Hetta Diab F, Ahmed Eman Hasan, Obiedallah Ahmed A, Elzohry Alaa Ali M
Department of Anesthesia, ICU and Pain Relief.
Department of Clinical Pathology, South Egypt Cancer Institute.
J Pain Res. 2017 Apr 12;10:887-895. doi: 10.2147/JPR.S122918. eCollection 2017.
Major abdominal cancer surgeries are associated with significant perioperative mortality and morbidity due to myocardial ischemia and infarction. This study examined the effect of perioperative patient controlled epidural analgesia (PCEA) on occurrence of ischemic cardiac injury in ischemic patients undergoing major abdominal cancer surgery.
One hundred and twenty patients (American Society of Anesthesiologists grade II and III) of either sex were scheduled for elective upper gastrointestinal cancer surgeries. Patients were allocated randomly into two groups (60 patients each) to receive, besides general anesthesia: continuous intra and postoperative intravenous (IV) infusion with fentanyl for 72 h postoperatively (patient controlled intravenous analgesia [PCIA] group) or continuous intra and postoperative epidural infusion with bupivacaine 0.125% and fentanyl (PCEA group) for 72 h postoperatively. Perioperative hemodynamics were recorded. Postoperative pain was assessed over 72 h using visual analog scale (VAS). All patients were screened for occurrence of myocardial injury (MI) by electrocardiography, echocardiography, and cardiac troponin I serum level. Other postoperative complications as arrhythmia, deep venous thrombosis (DVT), pulmonary embolism, pneumonia, and death were recorded.
There was a significant reduction in overall adverse cardiac events (myocardial injury, arrhythmias, angina, heart failure and nonfatal cardiac arrest) in PCEA group in comparison to PCIA group. Also, there was a significant reduction in dynamic VAS pain score in group PCEA in comparison to PCIA at all measured time points. Regarding perioperative hemodynamics, there was a significant reduction in intra-operative mean arterial pressure (MAP); and heart rate in PCEA group in comparison to PCIA group at most of measured time points while there was not a significant reduction in postoperative MAP and heart rate in the second and third postoperative days. The incidence of other postoperative complications such as DVT, pneumonia and in hospital mortality were decreased in PCEA group.
Perioperative thoracic epidural analgesia in patients suffering from coronary artery disease subjected to major abdominal cancer surgery reduced significantly postoperative major adverse cardiac events with better pain control in comparison with perioperative IV analgesia.
由于心肌缺血和梗死，腹部癌症大手术与围手术期显著的死亡率和发病率相关。本研究探讨围手术期患者自控硬膜外镇痛（PCEA）对接受腹部癌症大手术的缺血患者缺血性心脏损伤发生情况的影响。
120例择期行上消化道癌症手术的患者（美国麻醉医师协会分级为Ⅱ级和Ⅲ级），性别不限。患者被随机分为两组（每组60例），除全身麻醉外：术后72小时接受芬太尼持续静脉内及术后静脉输注（患者自控静脉镇痛[PCIA]组）或术后72小时接受0.125%布比卡因和芬太尼持续硬膜外输注（PCEA组）。记录围手术期血流动力学。术后72小时使用视觉模拟量表（VAS）评估疼痛。通过心电图、超声心动图和心肌肌钙蛋白I血清水平筛查所有患者心肌损伤（MI）的发生情况。记录其他术后并发症，如心律失常、深静脉血栓形成（DVT）、肺栓塞、肺炎和死亡情况。
与PCIA组相比，PCEA组总体不良心脏事件（心肌损伤、心律失常、心绞痛、心力衰竭和非致命性心脏骤停）显著减少。此外，与PCIA组相比，PCEA组在所有测量时间点的动态VAS疼痛评分均显著降低。关于围手术期血流动力学，与PCIA组相比，PCEA组在大多数测量时间点的术中平均动脉压（MAP）和心率显著降低，而术后第二天和第三天的术后MAP和心率没有显著降低。PCEA组其他术后并发症如DVT、肺炎和住院死亡率的发生率降低。
与围手术期静脉镇痛相比，接受腹部癌症大手术的冠心病患者围手术期胸段硬膜外镇痛显著降低了术后主要不良心脏事件，且疼痛控制更好。
