Effects of Continuous Epidural Infusion after Thoracic Epidural Anesthesia for Mastectomy on Postoperative Pain, Nausea and Vomiting

Abstract

Background: Breast cancer is the most common cause of tumors in Korean women. Until recently, oncologic breast surgery was performed by using general inhalation anesthesia. However, this anesthetic method is associated with incomplete postoperative pain control and significantly more postoperative nausea and vomiting (PONV). Therefore, this study examinated the value of thoracic epidural anesthesia (TEA) for a mastectomy, and evaluated the effects of a continuous epidural infusion on postoperative pain control and the PONV, which is known to be a better method than general anesthesia with intravenous patient controlled analgesia (IV PCA). Methods: Sixty five patients scheduled for a mastectomy were randomly assigned and divided into two groups. The GA group underwent general anesthesia using O2-N2O-sevoflurane with IV PCA. The TEA group was injected with 20 ml of 0.375% ropivacaine with fentanyl 50μg at T4－5. After surgery the visual analogue scale (VAS) score of postoperative pain and nausea was checked. Results: The postoperative pain intensity was significantly (P ＜ 0.05) lower in the TEA group at the postoperative period and during 6 hours compared with the GA group. Postoperative nausea intensity was significantly (P ＜ 0.05) lower in the TEA group during 6 hours. Conclusions: These results suggest that TEA is a method suitable of regional anesthesia for a mastectomy and a continuous epidural catheter infusion is more effective on postoperative pain control than general anesthesia with IV PCA. In addition, it is a good method for decreasing the PONV to a similar level as IV PCA with antiemetics. (Korean J Anesthesiol 2007; 52: 396~402)