China: Combined epidural–general anesthesia compared to general anesthesia alone does not improve overall or cancer-specific long-term survival, nor does it improve chances of recurrence-free survival, according to a recent study published in the journal, Anesthesiology.

An epidural is a procedure that injects a local anesthetic into the space around the spinal nerves in your lower back. Experimental and observational research suggests that combined epidural–general anesthesia may improve long-term survival after cancer surgery by reducing anesthetic and opioid consumption and by blunting surgery-related inflammation. Keeping this in mind, investigators from China collaborated with researchers from Cleveland, Ohio to test the primary hypothesis that combined epidural–general anesthesia improves long-term survival in elderly patients.

The study was a long-term follow-up of patients enrolled in a previous randomized control trial conducted at five hospitals. The inclusion criteria was patients aged 60 to 90 yr and scheduled for major noncardiac thoracic and abdominal surgeries. Among the 1,802 patients who were enrolled and randomized in the underlying trial, 1,712 were included in the long-term analysis; 92% had surgery for cancer. The median follow-up duration was 66 months (interquartile range, 61 to 80). They were randomly assigned to either combined epidural–general anesthesia with postoperative epidural analgesia or general anesthesia alone with postoperative intravenous analgesia. The primary outcome was overall postoperative survival. Secondary outcomes included cancer-specific, recurrence-free, and event-free survival.

Among patients assigned to combined epidural–general anesthesia, 355 of 853 (42%) died compared with 326 of 859 (38%) deaths in patients assigned to general anesthesia alone. The findings for cancer-specific survival were similar with combined epidural–general anesthesia (327 of 853 [38%]) and general anesthesia alone (292 of 859 [34%]). Recurrence-free survival was 401 of 853 [47%] for patients who had combined epidural–general anesthesia and 389 of 859 [45%] with general anesthesia alone.

The study clearly shows that in elderly patients having major noncardiac thoracic and abdominal surgery, combined epidural–general anesthesia compared to general anesthesia alone did not improve overall or cancer-specific long-term survival and also did not improve chances of recurrence-free survival.

"Either approach can therefore reasonably be selected based on patient and clinician preference," the researchers concluded.

Reference:

The study titled, "Long-term Survival after Combined Epidural–General Anesthesia or General Anesthesia Alone: Follow-up of a Randomized Trial," is published in the journal Anesthesiology.

DOI:https://pubs.asahq.org/anesthesiology/article-abstract/doi/10.1097/ALN.0000000000003835/115864/Long-term-Survival-after-Combined-Epidural-General