Effect of continuous thoracic epidural bupivacaine-fentanyl analgesia on postoperative outcome and mortality after abdominal aortic surgery

Abstract

Introduction. Continuous thoracic epidural analgesia (C-TEA) allows earlier postoperative mobilisation of patients and decreases the rate of complications. The above effects should be more prominent in older patients, with a higher risk according to American Society of Anesthesiology.
Postoperative outcome and mortality rate were assessed in all patients undergoing abdominal aortic reconstruction surgery during an 18-month period, treated with the postoperative C-TEA (prospective group A; n = 36). Results were compared with patients undergoing abdominal aortic surgery during the previous 18-month period, with the conventional postoperative analgesia with systemic analgesics (retrospective group B; n = 38).
Results. Both groups did not significantly differ considering the type of implanted prosthesis (simple/Y; A: 22/14 vs. B: 15/23; p = 0.103), the type of operation (emergency/elective; A: 4/32 vs. B: 7/31; p = 0.554) and gender (female; A: 3/36 vs. B: 5/38; p = 0.769). Between groups the only significant difference was observed in the mean patients’ age (A: 65.4 ± 5.6 vs. B: 68.6 ± 5.7; p = 0.0324, Student’s t-test), and, which was more pronounced, in the mortality rate (A: 3/36 vs. . B: 12/38; p = 0.0280, c² test).
Conclusions. Concluding, 1) the mortality rate was four times lower in patients treated with C-TEA than in patients with conventional postoperative analgesia, 2) we cannot exclude additional effects caused by the type of prosthesis or general medical patients’ condition on the mortality rate.