BACKGROUND: The study was done to compare the effects of thoracic epidural analgesia versus systemic opioid analgesia on lung mechanics in obese patients undergoing major gynecological procedures(abdominal hysterectomy, ovarian cyst, ovarian mass and abdominal explorations) We evaluated their analgesic efficacy over the first 12 postoperative hours after gynaecological surgeries , in a randomized, single-blind, clinical trial in 60 Patients divided into two equal groups , 30 patients in each group .
METHODS: Sixty Patients were randomized into two equal groups , 30 patients in each group Group I received general anaesthesia in combination with intravenous opioids, Group II received general anaesthesia in combination with thoracic epidural anaesthesia. General anaesthesia was induced with fentanyl 1-2 mcg/kg and propofol 1–3 mg/kg followed by rocuronium 0.6 mg/kg . Each patient was assessed for pulmonary function tests (PFTs) ,pethidine consumption, visual analogue pain scale (VAS) at rest and on movement, vital signs and presence of complications (nausea, vomiting, sedation and pruritis) postoperatively by a blinded investigator in the postanesthesia care unit (PACU) and at 1 , 3, 6, and12h postoperatively.
RESULTS: Group II patients showed significantly increased postoperative PFTs values compared with group I patients at 1,3 and 6 hours,the postoperative analgesia is more effective with group II than group I , ( Epidural > systemic opioid) and the postoperative consumption of pethidine in epidural group is lower than in opioid group. As regard complications during the study in all groups , complications as nausea , vomiting , pruritis and sedation were recorded which were more in systemic opioid than epidural .
CONCLUSION: Particularly for obese patients, Epidural anesthesia and postoperative epidural analgesia improve the postoperative respiratory function, compared with general anesthesia and systemic analgesia and reduce postoperative pain in obese patients undergoing major gynecological procedures.
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