Epidural Analgesia in Open Thoraco-abdominal Aortic Aneurysm Repair

Abstract

Epidural analgesia improves pain control and outcomes of abdominal aortic aneurysm procedures, while the effect of thoracic epidural analgesia on thoraco-abdominal aortic aneurysm (TAAA) repair is unknown. The aim of the study was to evaluate thoracic epidural analgesia effects in patients undergoing open TAAA repair in terms of pain control and clinically relevant outcomes. This was a retrospective study of a prospectively collected database. Patients undergoing open TAAA repair between January 2009 and December 2016. Four hundred and fifty-nine consecutive patients were included. Thoracic epidural analgesia was used in 409 (89%) of cases. On multivariable analysis, patients who received thoracic epidural analgesia experienced reduced post-operative pain (odds ratio [OR] 0.003, 95% confidence interval [CI] 0.0007-0.009; p<.001), a lower rate of acute kidney injury (AKI; OR 0.39, 95% CI 0.21-0.71 [p=.002]), atrial fibrillation (OR 0.47, 95% CI 0.23-0.95; p=.04), acute myocardial infarction (AMI; OR 0.189, 95% CI 0.05-0.64; p=.008), and paraplegia (OR 0.31, 95% CI 0.157-0.615; p=.001) compared with the conventional analgesia (CA) group. After propensity score matching, 43 patients in the CA group were compared with 43 in thoracic epidural analgesia group. On case match analysis thoracic epidural analgesia showed a significant reduction in post-operative pain (p<.001) and no differences in the incidence of AKI, atrial fibrillation, AMI, and paraplegia. In the thoracic epidural analgesia group there were no epidural haematomas. Thoracic epidural analgesia was effective in reducing post-operative pain with no effect on major post-operative complications. The use of thoracic epidural analgesia, if not contraindicated, might be considered in clinical practice, even in patients undergoing open TAAA repair. Whether a better post-operative management enhances patient's recovery in this setting remains to be tested.