Continuous thoracic epidural anesthesia with 0.2% ropivacaine versus general anesthesia for perioperative management of modified radical mastectomy

We evaluated in this prospective study the effectiveness of continuous thor acic epidural anesthesia (TEA) and postoperative analgesia with ropivacaine and compared it with general anesthesia (GA) and opioids for pain relief, side effects, postanesthesia recovery, and hospital discharge after modifie d radical mastectomy. Sixty ASA physical status II and III patients undergo ing mastectomy were randomly assigned to two study groups of 30 patients ea ch. In the TEA group, an epidural catheter was inserted at T6-7, and 5-10 m t of 0.2% ropivacaine was injected to maintain anesthesia and to continuous ly administer adequate analgesia for 48 h. GA was induced with IV 1-2 mg of midazolam or 50-100 mug/mL of fentanyl followed by 50-150 mg of propofol a nd was maintained with sevoflurane and 50% N2O in oxygen. The Aldrete score system was used to evaluate postanesthesia recovery, a verbal rating scale was used for assessment of pain intensity, and a postanesthesia discharge scoring system was used for discharge home. The demographic data and side e ffects (except for nausea and vomiting) (GA 43%, TEA 10%, P = 0.0074) and d ischarge home were similar in both groups. However, the number of patients ready for discharge from the recovery room during the first postanesthesia hour (Aldrete score of 10) was significantly larger after TEA (80%) than af ter GA (33%) (P = 0.0006). GA patients experienced significantly more (P < 0.001) substantial pain than TEA patients on Day 0 (70%), Day 1 (53%), and Day 2 (27%) after the surgery. Patient satisfaction was greater with TEA (7 0%) than with GA (30%) (P <less than> 0.001). WE conclude that TEA with rop ivacaine provides better postoperative pain relief and less nausea and vomi ting, facilitates postanesthesia recovery, and gives greater patient satisf action than GA.