A Comparative Study Of Thoracic Epidural Anaesthesia Using Bupivacaine And General Anaesthesia For Elective Breast Surgeries

Abstract

Introduction And Aim: Major surgery induced profound physiological changes in the perioperative period, characterized by increases in sympathoadrenal and other neuroendocrine activity and also increased cytokine production. Because epidural anesthesia can attenuate this “stress response†to surgery, improve the quality of postoperative analgesia in comparison with systemic opioids, and hasten recovery of gut function, it has been suggested that conducting surgery under epidural anesthesia (either as the sole anesthetic or in combination with general anesthesia) may reduce perioperative morbidity and mortality compared with general anesthesia alone. This clinical study was therefore under taken to evaluate the usefulness of employing the thoracic segmental epidural blocks for various breast surgeries. Method: The study included 60 patients of elective breast surgeries of age group 20 to 60 years after approval from institutional ethic committee. Informed written consent from all patients was taken. After thorough pre anesthetic check up and premedication in 30 patients of group T Epidural catheter was inserted at T5-6 level and 10 CC of 0.25% bupivacaine were injected for all patients and in 30 patients of group G conventional general anesthesia were given. The parameter studied were 1.Intra operative hemodynamic changes 2. Post operative analgesia 3. Post operative side effects – shivering, nausea and vomiting, backache and respiratory effect 4. Recovery time and 5. Duration of hospital stay. Result: Baseline demographic variables were similar in two groups. Intra operative hemodynamic changes were significant in early perioperative period in both groups. There was higher incidence of post operative side effects and intravenous analgesic requirement in group G compared to group T. Recovery time and duration of hospital stay were also higher in group G compared to group T. Conclusion: Thoracic epidural anesthesia compared to general anesthesia has different sets of intra operative hemodynamic changes. In both type of anesthesia this intra operative hemodynamic changes are easily manageable. Thoracic epidural has better postoperative outcome with much better post operative pain management which leads to decrease in recovery time and duration of hospital stay. So it can be considered that thoracic epidural anesthesia is better alternative for elective breast surgeries than general anesthesia