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Indian Journal of Anesthesia and Analgesia

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Is Thoracic Epidural Anesthesia a Better Alternative to General Anesthesia in Modified Radical Mastectomy Surgeries?

Gunaseelan S., Associate Professor, Department of Anaesthesiology, Sri Venkateshwara Medical College Hospital and Research Centre, Ariyur, Puducherry 605102, India. , Jalakandan B.1 , Gunaseelan S.2 , Raghuraman3

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Indian Journal of Anesthesia and Analgesia 5(10):p 1757-1764, Oct 2018. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.51018.27

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Abstract

  Background and objectives: Though the breast surgeries are usually performed under general anesthesia (GA), it is not without any attendant risks. Thoracic Epidural anesthesia (TEA) is gaining more attention in view of better intraoperative conditions, postoperative recovery profile and fewer postoperative complications. This study was designed to determine the efficacy and safety of TEA as an alternative anesthetic technique to GA for Modified radical mastectomy (MRM). Methodology: Group G (n = 25) was administered conventional GA. The Group T (n = 25) received TEA with 0.25% Bupivacaine and Fentanyl. Postoperative pain management was provided with Tramadol for GA patients and epidural infusion for TEA patients. The need for anesthesia supplementation, sedation, hemodynamic changes, respiratory depression and other intercurrences like pruritus, nausea, vomiting were recorded. The duration of surgery, length of stay in the recovery room and quality of post­operative analgesia were also recorded. Results: In group T, Supplementation with axillary infiltration was required in 20% of patients and all patients required sedation. Hypertension was more frequent in group G, whereas hypotension and bradycardia were more frequent in group T. Postoperatively, the incidence of nausea and vomiting were observed frequently in group G. The group G patients had longer duration of stay in recovery room (202.32 vs 160.80 minutes). The Visual Analog scores and requirement of supplementary analgesics upto 24 hours of postoperative period were significantly lower in group T patients. Conclusion: TEA is a safe, reliable and better alternative to GA in patients undergoing MRM. 

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.51018.27

Keywords

General Anesthesia; Modified Radical Mastectomy; Postoperative Analgesia; Thoracic Epidural Anesthesia

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