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. 2016 Feb;10(2):UC01-4.
doi: 10.7860/JCDR/2016/13942.7327. Epub 2016 Feb 1.

Serial Peak Expiratory Flow Rates in Patients Undergoing Upper Abdominal Surgeries Under General Anaesthesia and Thoracic Epidural Analgesia

Julie C R Misquith  1 , Rammoorthi Rao  2 , Karl Sa Ribeiro  3
Affiliations

Serial Peak Expiratory Flow Rates in Patients Undergoing Upper Abdominal Surgeries Under General Anaesthesia and Thoracic Epidural Analgesia

Julie C R Misquith et al. J Clin Diagn Res. 2016 Feb.

Abstract

Introduction: Anaesthesia and upper abdominal surgeries alter lung compliance and functional residual capacity resulting from atelectasis. Upper abdominal surgeries also cause a decrease in peak expiratory flow rates, cough reflex due to pain limited inspiration.

Aim: This study aimed to study the effect of thoracic epidural analgesia (TEA) on the peak expiratory flow rates in patients undergoing upper abdominal surgeries.

Materials and methods: A total of 44 patients posted for elective surgery were enrolled. Group 1 patients received GA + 0.125% bupivacaine infusion TEA and Group 2 received GA + Inj. Diclofenac sodium 50 mg slow i.v. TID for Postoperative analgesia. Haemodynamics, VAS pain score, PEFR measurements were done at 60 minutes, 24 hours, 48 hours and 4 days after surgery in both groups. ABG analysis was taken pre operatively and 24 hours after surgery.

Results: The SBP and DBP values obtained at 60 minutes (p<0.016) 24 and 48 hours (p<0.001) and day 4 (p<0.02) postoperative showed highly significant difference between the two groups which indicate better haemodynamic parameters in patients receiving epidural analgesia. Postoperatively the difference in PEFR values at 60 minutes, 24 hour, 48 hour and day 4 were very highly significant. (p<0.001). Group1 had a 10.739% deficit on day 4 from its pre operative baseline value while group 2 showed a 34.825 % deficit which was very highly significant (p<0.001). The difference in VAS scores recorded at 60 minutes, 24 hours, 48 hours and day 4 post op were very highly statistically significant (p < 0.001). The ABG taken at 24 hours shows statistically significant difference with patients in group 2 showing decreased values in pCO2 and pO2 reflecting poorer ventilation and oxygenation.

Conclusion: Thoracic epidural analgesia provides superior analgesia, better cough reflex as seen by better PEFR values, were haemodynamically more stable and their ABG values were better than the NSAID group.

Keywords: Diaphragmatic dysfunction; Hemodynamic stability; PEFR; Pain relief; VAS.

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References

    1. Lawrence VA, Page CP, Harris GD. Perioperative spirometry before and after abdominal operations: a critical appraisal of its predictive value. Archives of Intern Medicine. 1989;149:280–85. - PubMed
    1. McLeod G, Davies H, Munnoch N, Bannister J, Mac Rae W. Postoperative pain relief using thoracic epidural analgesia: outstanding success and disappointing failures. Anaesthesia. 2001;56:75–81. - PubMed
    1. Fratacc MD. Diaphragmatic shortening after thoracic surgery in humans. Effects of mechanical ventilation and thoracic epidural analgesia. Anaesthesiology. 1993;79:654–65. - PubMed
    1. Ford G, Whitelaw W, Rosenal T, et al. Diaphragm function after upper abdominal surgery in humans. American Review of Respiratory Diseases. 1987;127:431–36. - PubMed
    1. Meyers J, Lembeck L, O’Kane H, et al. Changes in functional residual capacity of the lung after operation. Arch Surg. 1975;110:576–83. - PubMed

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