Adjunct epidural anaesthesia may increase complications in patients of cystectomy
Cleveland, Ohio: Cystectomy patients who were managed with general anesthesia+epidural anaesthesia had more complications than those who received general anaesthesia alone, according to a recent study published in the journal Urology. Also, patients who received additional epidural had no advantages in terms of postoperative stay, reoperation rate, or readmission rate over the other group of patients.
Epidural anaesthesia is regional anaesthesia that blocks pain in a particular region of the body. Epidurals block the nerve impulses from the lower spinal segments resulting in a decreased sensation in the lower half of the body. It has been used as a part of the Enhanced Recovery After Surgery (ERAS) process to decrease postoperative narcotic use and improve various parameters of care.
The use of adjunct anaesthesia, such as an epidural, unlike many parts of the ERAS protocol, has not been evaluated to see whether it improved patient-centred outcomes.
Austin Fernstrum, Case Western Reserve University School of Medicine, Cleveland, Ohio, and colleagues conducted the study to identify differences in short term outcomes and readmission rates in cystectomy patients managed with general anaesthesia compared to those undergoing general anaesthesia and adjuvant epidural anaesthesia.
For the purpose, the researchers used data from the National Surgical Quality Inpatient Program on U.S. patients who underwent a cystectomy with ileal conduit between 2014 and 2017. Patients were subdivided based on anaesthesia modality. Baseline differences between subgroups - e.g., smoking, the prevalence of hypertension - were adjusted with propensity score-matching. 2,956 patients were included. The mean age was 70.4; 80.8% were men; and 56.1%, white
Key findings of the study include:
- There were no differences between the general anaesthesia alone and adjuvant epidural groups in terms of operative time (mean, 307.29 minutes), the proportion of patients needing transfusion (30.1% vs. 33.7%), reoperations (5.2% vs. 4.9%), and procedure-related readmissions (18.1% vs. 21.1%).
- Compared to general anaesthesia, adjuvant epidural anaesthesia was associated with increased odds of procedure-related complications (adjusted OR, 1.264) and an increasing trend for development of pulmonary emboli (1.8% vs. 0.5%).
According to the authors, regardless of whether the study findings are correct, there is no clear benefit to applying combination therapy for the average patient.
The study, "Epidural Anesthesia is associated with increased complications in Cystectomy Patients: A NSQIP Analysis," is published in the journal Urology.