The effect of epidural blockade on gastric intramucosal pH in the peri-operative period.

Patients undergoing major surgery are at risk of developing gut ischaemia and multiple organ failure. The gastric tonometer provides a relatively non-invasive method of assessing the adequacy of gut blood flow. Patients who develop repeated episodes of splanchnic ischaemia in the postoperative period, as evidenced by a low gastric intramucosal pH, have a higher mortality than those who do not. This randomised, controlled study was conducted to assess the effect of epidural blockade with bupivacaine on gastric intramucosal pH measurements in patients undergoing major surgery. A significantly lower proportion of patients with epidural blockade developed gastric intramucosal pH values < 7.32 postoperatively compared to controls (3/15 versus 13/16, p < 0.001). The significance of these results is discussed.