Thoracic epidural anesthesia for pain relief and postoperation recovery with modified radical mastectomy

The purpose of this study was to investigate whether thoracic epidural anes thesia (TEA) provides better postoperative pain relief and recovery than ge neral anesthesia (GA) for modified radical mastectomy (MRM) surgery. Sixty- four patients rated as American Society of Anesthesiologists (ASA) 1 to 3 w ho underwent MRM surgery were included in the study. In TEA group patients, 2% lidocaine (15-20 ml) was administered via the epidural route as primary anesthesia, in conjunction with midazolam (5-10 mg) and fentanyl (<250 mu g) for amnesia. The GA patients were maintained with isoflurane and 50% nit rous oxide in oxygen, After operation the patients were given pethidine (1 mg/kg IM) as required for pain relief. The time to first pethidine requirem ent, total pethidine consumption, worst pain score, bed rest time, satisfac tion score, and anesthesia-related side effects were recorded for 2 days af ter surgery. The results show that TEA provided a more prolonged analgesic effect than GA after operation. A longer time to first pethidine requiremen t (19.2 +/- 1.5 vs. 7.6 +/- 2.5 hours) (p < 0.001) and decreased pethidine consumption (17.2 +/- 7.0 vs. 76.3 +/- 17.4 mg) (p < 0.001) were observed i n the TEA group than in the GA group, respectively. A worse visual analog s cale (VAS) pain score was observed in the GA group (5.7 +/- 0.6) than in TE A patients (4.3 +/- 0.4) (p < 0.01), The average bed rest time was signific antly shorter in the TEA group (16.9 +/- 0.9 hours) (p < 0.01) than in the GA group (27.1 +/- 3.1 hours). Overall satisfaction scores were significant ly higher in the TEA group (4.4 +/- 0.1) (p < 0.01) than in the GA group (3 .5 +/- 0.2), Side effects were observed at a higher frequency in the GA gro up (16/32) (p < 0.0001) than in the TEA group (3/32). The frequency of peth idine injection for pain relief was significantly lower in the TEA group (8 /32) (p < 0.0001) than in the GA group (24/32). The total hospital cost (NT 61,392 +/- 3,523 vs. NT 53,806 +/- 2,817) (p = 0.0342) and anesthesia cost (NT 7,968 +/- 246 vs. NT 5,268 +/- 262) (p < 0.0001) are also significantl y lower in the TEA group than the GA group. In conclusion, TEA provided bet ter postoperative pain relief and recovery and lower cost than GA for MRM s urgery.