Assessment on Perioperative Outcome of Epidural Anesthesia & Analgesia

Abstract

Introduction: Epidural anesthesia and analgesia have the potential to reduce or eliminate the perioperative physiologic stress responses to surgery and thereby decrease surgical complications and improve outcomes. This study aimed to integrate experimental and clinical data addressing the physiologic effects of epidural anesthesia and postoperative epidural analgesia on surgical patients and to review the real and potential benefits of this technology concerning patient outcomes. Methods: This prospective observational study was conducted at the Department of Anesthesia, Upazilla Health Complex, Daganbhuiya, Feni, Bangladesh. The study was carried out from June 2020 to July 2021. A total of 110 patients were selected as study subjects as per inclusion criteria. Result: Out of 110 study subjects 20 (18.19%) subjects were in the 25-30 years age group, 30 (27.27%) were in the 31-35 years age group and the rest 60 (54.54%) were in >35 years, age group. Regarding the region of surgery done, 50% of subjects underwent lower abdominal surgery, 20% underwent surgery of lower extremities, 15% underwent labor pain, and the rest 15% underwent cardiothoracic surgery. Concerning intraoperative complication, hypotension was predominant which constituted 9% of total study subjects followed by nausea & vomiting seen in 3% of patients. 2.5% of patients had bradycardia, 2% experienced hypertension, only 1% of patients had tachycardia, and none experienced poor anesthesia. In terms of postoperative complications, post-dural puncture headache was predominant which was seen in 4% of patients, 2% had prolonged ICU stay, 2% had cardiopulmonary complications, 1% had postoperative pain, and 1% experienced occlusion of catheter and catheter fragment retention. It was seen that 95.5% of total patients did not need ephedrine or atropine, only 2% of patients needed ephedrine during the operation due to hypotension and 2.5% needed atropine during the operation due to bradycardia. Regarding the advantages of epidural anesthesia, reduced ileus was seen in 105 (95.45%) patients, reduced length of hospital stay in 108 (98.18%) patients, and reduced 30-day morbidity and mortality in 110 (100%) patients. The overall surgical outcome was excellent as well. In 98% of cases, the surgical outcome was satisfactory and only 2% showed poor surgical outcome. Conclusion: The effect of anesthetic and postoperative analgesic techniques on perioperative outcomes varies with the type of operation performed. Overall, epidural analgesia provides better postoperative pain relief and surgical outcomes.