Multimodal analgesia using intrathecal diamorphine, and paravertebral and rectus sheath catheters are as effective as thoracic epidural for analgesia post-open two-phase esophagectomy within an enhanced recovery program

• DOI: 10.1093/dote/doy006
• Publication Date: 2018-05-24T09:46:06Z
• Authors: C L Donohoe; A W Phillips; E Flynn; C Donnison; C L Taylor; R C F Sinclair; D Saunders; A Immanuel; S M Griffin
• Keywords: Esophagectomy; Rectus sheath

Thoracic epidural (TE) analgesia has been the standard of care for transthoracic esophagectomy patients since 1990s. Multimodal anesthesia using intrathecal diamorphine, local anesthetic infusion catheters (LAC) into paravertebral space and rectus sheaths intravenous opioid postoperatively represent an alternative option postoperative analgesia. While TE can provide excellent pain control, it may inhibit early recovery by causing hypotension reducing mobilization. The aim this study is to determine whether multimodal with LAC was effective respect adequate management, compare its impact on mobility. Patients receiving were matched propensity score matching undergoing two-phase trans-thoracic a over two-year period (from January 2015 December 2016). Postoperative endpoints that had evaluated prospectively, including scores movement at rest, inotrope or vasoconstrictor requirements, (systolic BP < 90 mmHg), compared between cohorts. Out 14 (13 male) received cohort age, sex, comorbidity. Mean maximum rest days 0 3 equivalent groups. In both cohorts, 50% more than 7 least one occasion. Fewer in group required (LAC: 36% vs. TE: 57%, P = 0.256) maintain blood pressure episodes 43% 79%, 0.05). able ambulate first day 64% 43%, 0.14) but these differences not statistically significant. Within cohort, three interruption due dislodgement failure block no disruption (P Therefore, spinal diamorphine combined sheath appears comparable relief post reliable safe current care.