Continuous Epidural Versus Non-Epidural Pain Management After Minimally Invasive Esophagectomy: A Real-Life,...

Area of Science:

• Anesthesiology
• Thoracic Surgery
• Oncology

Background:

• Minimally invasive esophagectomy (MIE) is increasingly preferred over open esophagectomy for esophageal cancer treatment.
• Effective postoperative pain management is crucial following esophagectomy.
• Various analgesic modalities exist, but their comparative efficacy after MIE requires further investigation.

Purpose of the Study:

• To compare the efficacy of thoracic epidural anesthesia (TEA) with non-TEA analgesic methods for postoperative pain management after MIE.
• To evaluate pain scores, surgical complications, and patient satisfaction across different analgesic techniques.

Main Methods:

• A retrospective review of 110 patients undergoing MIE between 2018 and 2023.
• Comparison of four analgesic groups: TEA, intravenous patient-controlled analgesia (PCA) alone, transversus abdominis plane (TAP) catheter with PCA, and paravertebral block (PVB) with PCA.
• Primary outcome: postoperative pain (Numeric Rating Scale) within 72 hours; Secondary outcomes: surgical complications (Clavien-Dindo classification), patient satisfaction.

Main Results:

• Paravertebral block (PVB) combined with PCA demonstrated comparable analgesic efficacy to thoracic epidural anesthesia (TEA).
• Pain scores during movement and at rest were similar between PVB+PCA and TEA groups.
• High patient satisfaction (85%) was reported across all analgesic groups, with no significant differences observed.

Conclusions:

• Paravertebral block (PVB) in combination with patient-controlled analgesia (PCA) is a viable alternative to thoracic epidural anesthesia (TEA) for managing postoperative pain after minimally invasive esophagectomy (MIE).
• This combination provides comparable analgesic efficacy and patient satisfaction to TEA.
• Further research may explore optimal strategies for multimodal pain management in MIE.