Feasibility of segmental thoracic epidural anesthesia in cancer patients undergoing feeding jejunostomy: A randomized controlled trial

  • Walaa Y. Elsabeeny Lecturer, Department of Anesthesia & Pain Management, National Cancer Institute, Cairo University, Kasr Al Eini Street, Fom El Khalig, Cairo, Egypt 11796.
  • Khaled Elsamahy Professor, Department of Anesthesia & Pain Management, National Cancer Institute, Cairo University, Kasr Al Eini Street, Fom El Khalig, Cairo, Egypt 11796.
  • Abdalla M. Elazab Lecturer, Department of Surgical Oncology, National Cancer Institute, Cairo University, Kasr Al Eini Street, Fom El Khalig, Cairo, Egypt 11796.
  • Mostafa A. Ibrahim Lecturer, Department of Anesthesia & Pain Management, National Cancer Institute, Cairo University, Kasr Al Eini Street, Fom El Khalig, Cairo, Egypt 11796.
DOI: https://doi.org/10.35975/apic.v25i5.1623
Keywords: Anesthesia, Epidural, General, Enteral Nutrition, Jejunostomy, Malnutrition

Abstract

Background: Malnourishment is very common in cancer patients secondary to the disease progression as well as the adverse effects of the treatment. Patients with gastroesophageal cancers and head and neck tumors are more prone to malnourishment. The enteral nutrition is the route of choice for nutritional support. Feeding jejunostomy is one of the routes used for long-term enteral nutrition. We compared the analgesia produced and the need of analgesics with the use of segmental thoracic epidural anesthesia (STEA) and general anesthesia (GA) for feeding jejunostomy.

Methodology: A total of 43 cancer patients scheduled for surgical feeding jejunostomy were enrolled and randomized into two groups; segmental thoracic epidural anesthesia group (Group STEA) (n = 21) and general anesthesia group (Group GA) (n = 22). The primary outcome was percentage of patients requiring rescue analgesia intraoperatively. Secondary outcome measures included hemodynamics, Visual Analogue Scale (VAS) scores, time to receive the first postoperative analgesic, total morphine consumption and any possible side effects or complications. Data were handled by SPSS v.25 (IBM©, Chicago, IL, USA). Data were expressed as mean ± standard deviation and analysed by unpaired student t-test, or median (range) and analysed using Mann Whitney-test. P < 0.05 was considered statistically significant.

Results: Significantly higher percentage of patients in the Group GA required intraoperative rescue fentanyl (59%) and postoperative morphine consumption (100%) compared to the Group STEA. Patients in GA group had higher heart rate (HR) and mean arterial blood pressure (MAP) values. Group SETA showed lower VAS scores in post anesthesia care unit (PACU) and throughout the first 24 hours postoperatively. The Group STEA had significantly higher patient satisfaction scores (PSS) and showed earlier ambulation.

Conclusions: Segmental thoracic epidural anesthesia has a better analgesic profile and can be used as a safe and effective alternative to general anesthesia in cancer patients undergoing surgical feeding jejunostomy.

Abbreviations: GA – General anesthesia; HR – Heart rate; IQR – Interquartile range; MAP – Mean arterial pressure; PACU – Post anesthesia care unit; PSS – Patient satisfaction score; STEA – Segmental thoracic epidural anesthesia; VAS – Visual Analogue Scale

 Key words: Anesthesia, Epidural; Anesthesia, General; Enteral Nutrition; Jejunostomy; Malnutrition.

Citation: Elsabeeny WY, Elsamahy K, Elazab AM, Ibrahim MA. Feasibility of segmental thoracic epidural anesthesia in cancer patients undergoing feeding jejunostomy: A randomized controlled trial. Anaesth. pain intensive care 2021;25(5):583–590; DOI: 10.35975/apic.v25i5.1623

Received: April 29, 2021; Reviewed: August 5, 2021; Accepted: August 5, 2021

 

Published
09-21-2021
How to Cite
Elsabeeny, W., Elsamahy, K., Elazab, A., & Ibrahim, M. (2021). Feasibility of segmental thoracic epidural anesthesia in cancer patients undergoing feeding jejunostomy: A randomized controlled trial. Anaesthesia, Pain & Intensive Care, 25(5), 583–590. https://doi.org/10.35975/apic.v25i5.1623
Issue
Vol 25 No 5 (2021): September-October
Section
ORIGINAL RESEARCH