Haemodynamic and ventilatory effects of preoperative epidural analgesia during laparoscopic hysterectomy using NICO

The pneumoperitoneum and the head-down tilt positions required for laparoscopy may induce pathological, haemodynamic and ventilatory changes that complicate anaesthetic management. The purpose of the study was to evaluate the effect of preoperative epidural analgesia on intraoperative haemodynamic and ventilatory parameters during laparoscopic hysterectomy using the non-invasive cardiac output with partial carbon dioxide rebreathing technique (NICO).

50 female patients were enrolled in this study. One percent lidocaine 15 ml with epinephrine and 2 mg morphine were administered via an epidural catheter before the induction of anaesthesia in the epidural group (n = 25), but not in the control group (n = 25). NICO was connected and monitored to the ventilatory circle. We also compared the quality of postoperative pain control.

The blood pressures in the epidural group were significantly lower than the control group immediately after the Trendelenburg position. Stroke volume, cardiac output, and cardiac index were significantly higher in the epidural group, than in the control group during the entire surgery. Dynamic compliances after gas exsufflation were significantly higher, and production of carbon dioxide was lower after pneumoperitoneum in the epidural group, than in the control group. In the epidural group, the postoperative pain scores and the additional analgesic requirements were significantly lower than in the control group.

We concluded that preoperative epidural analgesia provides not only more effective postoperative pain control, but also offer higher cardiac output and cardiac index, higher dynamic compliance, and lower production of carbon dioxide during the laparoscopic hysterectomy.