Effect of epidural block on postoperative long-term quality of life in patients undergoing radical operation for lung cancer under general anesthesia

Abstract

Objective To evaluate the effect of epidural block on postoperative long-term quality of life in patients undergoing radical operation for lung cancer under general anesthesia. Methods A total of 348 patients with primary non-small cell lung cancer of both sexes, aged 18-80 yr, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, with body mass index of 18-30 kg/m2, with International Association for the Study of Lung Cancer staging criteria stage 1-2, scheduled for elective radical operation for lung cancer under general anesthesia, were divided into 2 groups (n=174 each) using a random number table method: general anesthesia plus patient-controlled intravenous analgesia (PCIA) group (group G) and general anesthesia plus epidural anesthesia plus patient-controlled epidural analgesia group (group GE). Anesthesia was induced by target-controlled infusion of propofol and fentanyl and intravenous injection of rocuronium.The patients were tracheally intubated and mechanically ventilated to maintain the end-tidal pressure of carbon dioxide at 30-40 mmHg.Anesthesia was maintained by target-controlled infusion of propofol and intravenous injection of remifentanil.An increment of fentanyl was given immediately after chest opening and closing, and cisatracurium besylate was injected intravenously.In group GE, 0.375% ropivacaine was epidurally injected in a initial dose of 5-8 ml followed by continuous epidural infusion at 5 ml/h, and infusion was stopped before closing the chest.Bispectral index value was maintained at 40-60 during operation.PCIA was performed at the end of operation with fentanyl, flurbiprofen, ramosetron or palonosetron hydrochloride, and the PCA pump was set up with a 0.5 ml bolus dose, a 15-min lockout interval and background infusion at a rate of 2 ml/h in group G. Patient-controlled epidural analgesia was performed with 0.15%-0.18% ropivacaine 250 ml, and the PCA pump was set up to deliver 2-3 ml bolus dose with a 20-min lockout interval and background infusion at 4-5 ml/h in group GE.Postoperative analgesia was performed until 48 h after operation in both groups.Patients were followed up by telephone at half a year and 1 and 2 yr after operation.The 12-item short-form scale was used to evaluate the quality of life.Physical component summary (PCS-12) and mental component summary (MCS-12) scores were calculated. Results PCS-12 and MCS-12 scores were significantly lower at 2 yr after operation than at half a year in both groups (P<0.05). Compared with group G, PCS-12 and MCS-12 scores were significantly increased at 2 yr after operation in group GE (P<0.05). Conclusion Compared with general anesthesia alone, epidural block provides better effect on postoperative long-term quality of life in patients undergoing radical operation for lung cancer under general anesthesia. Key words: Anesthesia, general; Anesthesia, epidural; Analgesia, patient-controlled; Quality of life