Comparison of the use of thoracic epidural analgesia in a wake patients versus general anesthesia undergoing intra-abdominal surgery

PURPOSE: Our goal was to compare the efficacy and side effects of thoracic epidural anesthesia or general anaesthesia during intra-abdominal surgery. METHODS: A hundred twenty-five patients were randomized to receive thoracic epidural anesthesia in awake patients (Group TEA) or general anesthesia (Group GA) in a prospective, randomized study. Preoperatively, all patients received a thoracic epidural catheter. Bolus dose of bupivacaine with fentanyl, was given to Group TEA. Patient-controlled epidural analgesia was maintained with an infusion of bupivacaine with fentanyl in both groups just after the end of surgery. RESULTS: Intraoperative mean arterial pressure values at 10,15,30,45 min, heart rate values at 5,10,15,30 min were significantly less in Group TEA in comparison to Group GA(P<0.05). At 2 hours after operation, pain (resting and coughing) scores(P<0.0001) and postoperative total analgesic consumption were significantly less (P=0.008) in Group TEA in comparison to Group GA. The length of hospital stay was significantly short(P=0.03) and total hospital costs were significantly less(P=0.042) in Group TEA than Group GA. CONCLUSIONS: During intra-abdominal surgery, TEA in awake patients have better analgesic effect at two hours postoperatively, less analgesic consumption, shorter hospital stay and less hospital costs. However, clinicians must pay attention to intraoperative hypotension and bradycardia during use of thoracic epidural anesthesia in awake patients.