Oesophagogastrectomy in the elderly high risk patients: Role of effective regional analgesia and early mobilisation

Background. Oesophagogastrectomy is the best available treatment for patien ts with carcinoma of the oesophagus of cardia. However, surgical resection may lead to increased mortality, morbidity and longer hospital stays in eld erly (aged over 70 years) high risk patients. Methods. To assess the impact of balanced pre-emptive and postoperative ana lgesia combined with early mobilisation in elderly patients undergoing oeso phagogastrectomy we consecutively studied 52 patients (30 male, 22 female) of 75+/-4.2 years of age (mean+/-SD). Pre-emptive analgesia was by pre-inci sional percutaneous paravertebral block combined with an opiate and a nonst eroidal anti-inflammatory drug (NSAID) premedication. Postoperative mainten ance analgesia was by NSAID and continuous extrapleural intercostal nerve b lock. Following surgery all but three patients were returned to the ward. Results. The hospital mortality rate was 7.6%. Morbidity caused by cardiova scular (27%), respiratory (23%) and cerebrovascular (19%) complications occ urred in 19 patients, with two patients requiring ventilatory support. The mean hospital stay for the survivors was 10 days (range 8 to 30 days). All the survivors had their swallowing restored to normal and returned to their accustomed environment. Conclusions, These data suggests that surgical tre atment can be achieved in the elderly high risk patients with acceptable mo rtality and morbidity. This is achieved by early mobilisation enabled by ba lanced pre-emptive and postoperative analgesia.