THORACIC EPIDURAL-ANESTHESIA IMPROVES OUTCOME AFTER BREAST SURGERY

Objective The authors' objective was to compare the outcomes, includin g the incidence of nausea and vomiting and the time until discharge to home, of patients undergoing general anesthesia and thoracic epidural anesthesia for oncologic breast procedures. Summary Background Data G eneral anesthesia is the traditional anesthetic technique used in onco logic breast procedures. In March 1993, the authors initiated the use of high thoracic epidural anesthesia for patients undergoing oncologic breast surgery and reconstructive procedures. Methods A retrospective analysis was undertaken of 136 operations performed by one surgeon (T .J.E.) al Brigham and Women's Hospital. A chi square analysis was used to compare the outcomes of patients undergoing general anesthesia and thoracic epidural anesthesia. Results Compared with general anesthesi a, thoracic epidural anesthesia was associated with a statistically si gnificant earlier hospital discharge (p = 0.01). For quadrantectomy/ax illary node dissection procedures, 20 of 39 patients (51%) having thor acic epidural anesthesia were discharged on the operative day versus 7 of 32 patients (22%) in the general anesthesia group. Furthermore, 8 of 39 patients (20%) in the thoracic epidural group experienced nausea and/or vomiting during their hospital stay versus 18 of 32 patients ( 56%) in the general anesthesia group (p = 0.002). Conclusion Thoracic epidural anesthesia is a safe technique not associated with neurologic or respiratory complications. The use of thoracic epidural anesthesia for breast surgery could improve patients' recovery and reduce the co st of these procedures.