The study was conducted to compare the effects of thoracic epidural analgesia
versus systemic opioid analgesia on lung mechanics in obese patients undergoing
major gynecological procedures (abdominal hysterectomy, ovarian cyst, ovarian
mass, and abdominal explorations). We evaluated their analgesic efficacy over the
first 12 postoperative hours after gynecological surgeries, in a randomized, singleblind, clinical trial in 60 patients divided into two equal groups, with 30 patients in
each group.
Patients and methods
Sixty patients were randomized into two equal groups, with 30 patients in each
group: group I received general anesthesia in combination with intravenous opioids,
and group II received general anesthesia in combination with thoracic epidural
anesthesia. General anesthesia was induced with fentanyl 1–2 μg/kg and propofol
1–3 mg/kg followed by rocuronium 0.6 mg/kg. Each patient was assessed for
pulmonary function tests, pethidine consumption, visual analog pain scale at
rest and on movement, vital signs and the presence of complications (nausea,
vomiting, sedation, and pruritus) postoperatively by a blinded investigator in the
postanesthesia care unit and at 1, 3, 6, and 12 h postoperatively.
Results
Group II patients showed significantly increased postoperative pulmonary function
test values compared with group I patients at 1, 3, and 6 h; the postoperative
analgesia is more effective with group II than with group I (epidural>systemic
opioid), and the postoperative consumption of pethidine in the epidural group is
lower than in the opioid group. As regards complications during the study in all
groups, complications such as nausea, vomiting, pruritus, and sedation were
recorded, which were more in the systemic opioid group than in the epidural group.
Conclusion
Particularly for obese patients, epidural anesthesia and postoperative epidural
analgesia improve the postoperative respiratory functions, compared with general
anesthesia and systemic analgesia, and reduce postoperative pain in obese
patients undergoing major gynecological procedures.