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A5147 - Thoracic Epidural Analgesia with Local Anesthetics Improves Diaphragmatic Dysfunction After Laparoscopic Gastrectomy
Author Block: N. Fujimura, M. Asada, K. Nobukuni, T. Nakagaki, J. Yoshino; Anesthesiology, St. Mary's Hospital, Kurume, Japan.
BACKGROUND: Diaphragmatic dysfunction is a major factor in the etiology of respiratory complications after upper abdominal surgery. Diaphragmatic dysfunction is considered to be result from inhibitory reflexes of phrenic nerve activity. Thoracic epidural analgesia with local anesthetics improved diaphragmatic dysfunction by attenuating inhibitory reflexes. However, the relief of pain by opiate administration alone could not alter diaphragmatic dysfunction after upper abdominal surgery. Recently, laparoscopic gastrectomy has been widely performed with its advantages of reduced morbidity with early recovery and decreased postoperative pain. It has been expected that laparoscopic gastrectomy may reduce postoperative diaphragmatic dysfunction. However, the changes in diaphragmatic function after laparoscopic gastrectomy is not known. Furthermore, the role of thoracic epidural analgesia with local anesthetics on diaphragmatic function after laparoscopic gastrectomy is not clear. Thus the purpose of this study is to investigate the effects of thoracic epidural analgesia with local anesthetics on diaphragmatic function after laparoscopic gastrectomy using respiratory inductive plethysmography (RIP). METHODS: Sixteen healthy patients for laparoscopic gastrectomy were divided into two groups; The first group of patients with continuous extradural infusion of ropivacaine (group EPI) and the second group of patients with intravenous infusion of fentanyl (group ivPCA) for post-operative pain relief. Abdominal contribution to tidal volume (%AB) and respiratory timing were measured before surgery and on postoperative days (POD) 1, 3, 5 and 7. Visual analogue scale (VAS) score was measured on POD1, 3, 5 and 7. ANOVA was used for statistical analysis. RESULTS: The %AB of POD1 and 3 in group ivPCA were significantly decreased compared to those of the preoperative value. The %AB of POD1 and 3 in group EPI were significantly higher than those in group ivPCA. There were no significant differences between the VAS scores in the two groups. CONCLUSIONS: Continuous thoracic extradural infusion of ropivacaine improved diaphragmatic dysfunction after laparoscopic gastrectomy.