Background
Open oesophagectomy involves significant postoperative pain, which necessitates effective analgesic management to improve patient outcomes and recovery. Thoracic epidural analgesia remains the gold standard, providing superior pain control and facilitating early mobilization and respiratory function. However, there are concerns that the risk of hypotension and infectious complications.
Alternative methods, such as paravertebral blocks are gaining popularity due to their technically reduced side effects, however data in literature highlights the superior analgesia given via thoracic epidural versus paravertebral blocks. With advances in ERAS protocols, combined with the multi-disciplinary team’s greater comfort in administering and managing thoracic epidurals, this study looks at outcomes in thoracic epidural analgesia in oesophagectomies.
Methods
Retrospective cohort study performed at the Sunshine Coast University Hospital (SCUH). Fourty-five consecutive patients from January 1 2019 to August 1 2024 who underwent open oesophagectomy (Ivor-Lewis or McKeown) were retrospectively analysed for demographics, ICU length of stay, days on vasopressor, epidural complication, concurrent IV opiate requirement and complications.
Results
Average days on thoracic epidural was 4 days (range 1-7 days), 1 day on vasopressors (0-3 days), 3.6 days in ICU (1-6 days), no epidural complications were observed in the assessed period and 20% of patients required concurrent IV analgesia. AF was observed in 8% of patients, Pulmonary complications in 24% and the median length of stay was 15 days.
Conclusion
Thoracic epidural is an effective mode of analgesia, reducing IV opiate requirements in the crucial immediate post-operative phase with a low-complication rate profile.