RESUMEN
BACKGROUND: To study the risks of haemodynamic instability, and the possible occurrence of spinal haematoma, meningitis and epidural abscess when epidural analgesia is performed for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS: We retrospectively analyzed the data of 35 patients treated by HIPEC with oxaliplatin or cisplatin. An epidural catheter was inserted before induction of general anaesthesia. Postoperatively, a continuous epidural infusion of ropivacain, then a patient-controlled epidural analgesia were started. RESULTS: The epidural catheter was used peroperatively before HIPEC in 12 subjects (34%), and after HIPEC in 23 subjects (66%). The median dose of ropivacain given peroperatively in the epidural catheter was 40 mg (30-75). Norepinephrin was used in two subjects (6%) peroperatively (median infusion rate 0.325 µg/kg per minute [0.32-0.33]), and in four subjects (11%) in the postoperative 24 hours. No spinal haematoma, meningitis or epidural abscess were noted. Five subjects (14%) had a thrombopenia or a prothrombin time less than 60% before catheter removal. Two subjects (6%) had a leukopenia before catheter removal. No thrombopenia or blood coagulation disorders were recorded the day of catheter removal. CONCLUSION: In this series of 35 patients, the use of epidural analgesia for HIPEC does not seem to be associated with a worse risk of haemodynamic instability, spinal haematoma, meningitis or epidural abscess. HIPEC with platinum salt is not incompatible with the safety of epidural analgesia, with an optimized fluid management peroperatively and the following of perimedullary anesthesia practice guidelines.
Asunto(s)
Analgesia Epidural/métodos , Carcinoma/cirugía , Neoplasias Peritoneales/cirugía , Adulto , Anciano , Analgesia Epidural/efectos adversos , Analgesia Controlada por el Paciente , Anestesia General , Antineoplásicos/administración & dosificación , Antineoplásicos/uso terapéutico , Carcinoma/tratamiento farmacológico , Cisplatino/uso terapéutico , Terapia Combinada , Absceso Epidural/epidemiología , Absceso Epidural/etiología , Femenino , Hematoma Espinal Epidural/epidemiología , Hematoma Espinal Epidural/etiología , Hemodinámica/fisiología , Humanos , Hipertermia Inducida , Masculino , Meningitis/epidemiología , Meningitis/etiología , Persona de Mediana Edad , Norepinefrina/uso terapéutico , Compuestos Organoplatinos/uso terapéutico , Oxaliplatino , Neoplasias Peritoneales/tratamiento farmacológico , Estudios Retrospectivos , Riesgo , Seguridad , Trombocitopenia/etiología , Vasoconstrictores/uso terapéuticoRESUMEN
OBJECTIVES: Decrease acute pain after breast cancer surgery by an infiltration of ropivacaine. Analyse effect on chronic pain. STUDY DESIGN: Prospective randomised double blind versus placebo study. PATIENTS AND METHODS: Eighty-one patients randomised between two groups received wound infiltration with 40 ml of ropivacaine 4.75 mg/ml or placebo. Acute pain was assessed during 24h with analogical visual scale and antalgic consumption. One year later, telephonic interviews looked for chronic pain and evaluate it with McGill Pain Questionnaire. RESULTS: Analogical visual scale pain score, antalgic consumption and chronic pain incidence were similar between groups. CONCLUSION: Ropivacaine scar infiltration provided no acute or chronic pain relief after breast cancer surgery.