RETROSPECTIVE ANALYSIS OF SEGMENTAL EPIDURAL ANAESTHESIA FOR ABDOMINAL SURGERIES

Pooja Bhosle, Shubhada Aphale, Arunima PrasadShubhada Aphale, Arunima Prasad,

Abstract


A retrospective analysis of segmental epidural anaesthesia for upper and lower abdominal surgeries in 30 patients was undertaken. Epidural anaesthesia is a regional anesthetic technique that has a specific advantage in that selective segments can be blocked along with providing postoperative analgesia. We explored this advantage in selective cases. The patients were within the age group of 26-70 yrs with 67% females. Upper abdominal surgeries included open cholecystectomy, epigastric hernia repair, pyelolithotomy, upper ureterolithotomy, duodenal perforation. Lower abdominal surgeries like loop colostomies, umbilical and incisional hernia repairs with abdominoplasty were studied. Both routine (76.67%) and emergency (23.33%) cases were included into the study group. Patients with comorbidities like diabetes mellitus, chronic hypertension, respiratory disease, muscular dystrophy were part of the study group. The epidural catheter was placed at a level appropriate for the surgery to be undertaken and the segments required to be blocked. Local anaesthetic (lignocaine and bupivacaine) dose was as per the weight of the patient with appropriate age related reduction in geriatric patients. All patients were supplemented with oxygen. 23.33% of the patients required sedation. 23.33% developed hypotension which responded to IV fluids and vasopressors. 50% required post-operative epidural analgesia. In 23% of the patients in whom lower thoracic segments were blocked, none complained of any respiratory difficulty. To summarise, all our patients were operated under segmental epidural anaesthesia without any intraoperative complications. The regional technique was supplemented with light sedation. Thus, segmental epidural should be considered as a very good choice in patients with respiratory problems, muscular dystrophy or in the geriatric patients. The surgeries under segmental epidural anaesthesia have better outcome with surgeon’s & patient’s cooperation.

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