PMID- 30762735
OWN - NLM
STAT- MEDLINE
DCOM- 20190314
LR  - 20221005
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 98
IP  - 7
DP  - 2019 Feb
TI  - Effects of thoracic epidural anesthesia/analgesia on the stress response, pain 
      relief, hospital stay, and treatment costs of patients with esophageal carcinoma 
      undergoing thoracic surgery: A single-center, randomized controlled trial.
PG  - e14362
LID - 10.1097/MD.0000000000014362 [doi]
LID - e14362
AB  - BACKGROUND: Appropriate postoperative pain management can improve outcomes in 
      patients with esophageal cancer (EC). OBJECTIVE: To compare different 
      combinations of anesthesia and analgesia techniques in patients with EC 
      undergoing open thoracotomy. METHODS: This randomized, controlled, open-label 
      trial enrolled 100 patients with EC (aged 40-65 years; American Society of 
      Anesthesiologists [ASA] grade I/II) receiving elective surgery at Jiangsu 
      Province Hospital (China) between July 2016 and December 2017. Patients were 
      randomized to 4 groups (n = 25 per group): total intravenous general anesthesia 
      plus patient-controlled intravenous analgesia (TIVA/PCIA); TIVA plus 
      patient-controlled epidural analgesia (TIVA/PCEA); thoracic epidural anesthesia 
      with intravenous general anesthesia plus PCIA (TEA-IVA/PCIA); and TEA-IVA/PCEA 
      (TEA-IVA plus PCEA). Primary outcomes were plasma cortisol level (measured at 
      baseline, 2 h after skin incision, surgery completion, and 24 and 48 h 
      post-surgery) and pain (assessed at 24, 48, and 72 hours post-surgery using a 
      visual analog scale). Secondary outcomes included time to first flatus, hospital 
      stay and treatment costs. Postoperative adverse events (AEs) were analyzed. 
      RESULTS: Baseline and operative characteristics were similar between the 4 
      groups. Plasma cortisol level increased (P <.05 vs baseline) earlier in the TIVA 
      groups (2 h after skin incision) than in the TEA-IVA groups (24 h after surgery). 
      At 48 hours after surgery, plasma cortisol had returned to baseline levels in the 
      PCEA groups but not in the PCIA groups. VAS pain scores at rest and during 
      coughing were lower in the PCEA groups than in the PCIA groups (P <.05). Compared 
      with the PCIA groups, the PCEA groups had shorter time to first flatus and 
      shorter hospital stay, while use of TEA-IVA lowered the costs of intraoperative 
      anesthesia (P <.05). However, the PCEA groups had a higher incidence of nausea, 
      vomiting, and pruritus. CONCLUSION: Thoracic epidural anesthesia/analgesia can 
      reduce the stress response, improve postoperative recovery and reduce hospital 
      stay and costs for patients with EC.
FAU - Li, Yan
AU  - Li Y
AD  - Department of Anesthesiology, The first affiliated hospital of Nanjing Medical 
      University, Nanjing, 210029, China.
FAU - Dong, Hongquan
AU  - Dong H
FAU - Tan, Shanbai
AU  - Tan S
FAU - Qian, Yanning
AU  - Qian Y
FAU - Jin, Wenjie
AU  - Jin W
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Analgesics, Opioid)
RN  - WI4X0X7BPJ (Hydrocortisone)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Analgesia, Epidural/methods
MH  - Analgesia, Patient-Controlled/methods
MH  - Analgesics, Opioid/administration & dosage
MH  - Anesthesia, Epidural/methods
MH  - Anesthesia, General/methods
MH  - China
MH  - Combined Modality Therapy
MH  - Esophageal Neoplasms/*surgery
MH  - Female
MH  - Hospital Charges/statistics & numerical data
MH  - Humans
MH  - Hydrocortisone/blood
MH  - Length of Stay/statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Pain Management/*methods
MH  - Pain Measurement
MH  - Pain, Postoperative/*drug therapy
MH  - Thoracic Surgical Procedures/*methods
PMC - PMC6408022
COIS- The authors have no conflicts of interest to disclose.
EDAT- 2019/02/15 06:00
MHDA- 2019/03/15 06:00
PMCR- 2019/02/15
CRDT- 2019/02/15 06:00
PHST- 2019/02/15 06:00 [entrez]
PHST- 2019/02/15 06:00 [pubmed]
PHST- 2019/03/15 06:00 [medline]
PHST- 2019/02/15 00:00 [pmc-release]
AID - 00005792-201902150-00012 [pii]
AID - MD-D-18-06299 [pii]
AID - 10.1097/MD.0000000000014362 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2019 Feb;98(7):e14362. doi: 10.1097/MD.0000000000014362.