Dual-epidural catheter technique and perioperative outcomes after ivor-lewis esophagectomy

Michael J. Brown, Daryl J. Kor, Mark S. Allen, Michelle O. Kinney, K. Robert Shen, Claude Deschamps, Francis C. Nichols, William D. Mauck, Carlos B. Mantilla

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Background: Ivor-Lewis esophagectomy is associated with significant postoperative analgesic requirements and perioperative complications. A dual-epidural technique may improve perioperative outcomes compared with single thoracic epidural analgesia. Methods: This study identified all cases of Ivor-Lewis esophagectomy over a 3-year period. Eighty-one patients undergoing Ivor-Lewis esophagectomy who received general anesthesia supplemented by neuraxial analgesia with dual-epidural catheters (DECs) were matched 1:1 with patients who received general anesthesia and a single thoracic epidural catheter. Primary outcomes included quality of analgesia at rest and with movement on each of the first 3 postoperative days. Secondary outcomes included adverse events and the incidence of 4 major postoperative complications (anastomotic leak, pulmonary complications, atrial fibrillation, and sepsis). Results: A DEC technique significantly improved analgesia (evidenced by reduced pain with movement on each of the first 3 postoperative days) when compared with a single epidural catheter technique. The placement of DECs did not increase catheter-related adverse events. A DEC technique was associated with a 50% reduction in the combined rate of major postoperative complications (36% vs 18%; odds ratio, 0.40; P = 0.01) and increased number of hospital-free days measured at day 28 (21.2 vs 22.3; P = 0.04). Conclusions: The DEC technique improved postoperative analgesia and reduced the incidence of major postoperative complications and hospital length of stay in patients undergoing Ivor-Lewis esophagectomy. Future studies should evaluate the efficacy of this technique in a controlled randomized clinical trial.

Original languageEnglish (US)
Pages (from-to)3-8
Number of pages6
JournalRegional Anesthesia and Pain Medicine
Volume38
Issue number1
DOIs
StatePublished - Jan 1 2013

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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