Effect Of Anesthesia Without Opioid On Postoperative Complications In Patients With Esophageal Cancer Undergoing Radical Resection

Objective:To observe whether anesthesia without opioid combined with epidural anesthesia can reduce the postoperative complications in esophageal cancer radical operation.Methods:A total of 72 patients,aged 40 to 74 years,underwent radical resection of thoracotomy for esophageal cancer under general anesthesia.The American Society of Anesthesiologists?ASA?grade II^III.All patients were randomly divided into two groups:Group A and Group B.Group A was general anesthesia group.Thoracic epidural puncture was performed before general anesthesia.Epidural administration of 1%lidocaine 5 mL,after measuring the anesthetic level the general anesthesia induction was performed.Patients were induced by intravenous injection of midazolam,sufentanil,propofol,rocuronium.Tetracaine was used to anesthetize larynx and endotracheal surface before intubation,and then tracheal intubation was performed.Remifentanil,sevoflurane,dexmetomidine,propofol,rocuronium,continuous epidural analgesia were used to maintain anesthesia during operation.When patient recovered consciousness after the operation,the trachea catheter was extubated and the patients were sent to the postanesthesia care unit?PACU?,meanwhile the patient controlled epidural analgesia?PCEA?was performed.Group B was treated with general anesthesia without opioid combined with epidural anesthesia.Thoracic epidural puncture was performed before general anesthesia.Epidural administration of 1%lidocaine 5 mL,after measuring the anesthetic level the general anesthesia induction was performed.Patients were induced by intravenous injection of midazolam,propofol,rocuronium.Before intubation,tetracaine was used to anesthetize larynx and endotracheal surface,and then tracheal intubation was performed.Sevoflurane,dexmetidine,propofol,rocuronium,continuous epidural analgesia were used to maintain anesthesia during operation.After the operation,patient recovered consciousness,the trachea catheter was extubated,then the patient was sent to the postanesthesia care unit?PACU?,meanwhile the patient controlled epidural analgesia?PCEA?was performed.Both two groups had invasive arterial monitoring before induction,and bispectral index?BIS?of electroencephalogram were used to monitor the anesthetic depth,the BIS value was maintained between 40 and 60 during operation.Mean arterial blood pressure?MAP?,heart rate?HR?and finger oxygen saturation?SpO₂?during the induction period:before induction?T₀?,after induction?T₁?,immediately intubation?T₂?,1 minute after intubation?T₃?,3 minutes after intubation?T₄?,5 minutes after intubation?T₅?;during the operation period:at the beginning of the operation?T_a?and 60minutes after the operation began?T_b?and 120 minutes after the operation began?T_c?,the end of the operation?T_d?,and at the time of tracheal catheter extubation?T_e?;and 48 hours after surgery:2 hours after surgery,12 hours after surgery,24 hours after surgery,36 hours after surgery,48hours after surgery were recorded.Intraoperative liquid intake and output volume were recorded.The time of induction intubation,operation,postoperative PACU observation,postoperative ICU stay and postoperative hospitalization days were recorded.The incidence of postoperative complications?respiratory inhibition,nausea and vomiting,skin itching,urine retention,dizziness and fatigue?and severe pulmonary complications were observed.Results:66 patients were included in the statistical analysis,33 cases in group A and 33 cases in group B.There was no significant difference in general data between the two groups.The incidence of postoperative complications in group B was significantly lower than that in group A.The incidence of postoperative pulmonary complications in group B was significantly lower than that in group A?P<0.05?;The extubation time and PACU time in group B were significantly lower than those in group A?P<0.05?,and the ICU stay time and postoperative hospital stay days were significantly shorter in group B than in group A?P<0.05?.There was no significant difference in intubation time and operative time between the two groups.There was no significant difference between the two groups of intraoperative liquid intake and output volume.The heart rate in group B was higher than that in group A during induction?P<0.05?;The MAP,HR of T_a in group B was higher than that in group A?P<0.05?,but there was no significant difference in MAP,HR of T_b,T_c,T_d,T_e between two groups.There was no significant difference in SpO₂ of T_a,T_b,T_c,T_d,T_e between the two groups.There was no significant difference in VAS score between the two groups.Conclusion:Anaesthesia without opioid can reduce postoperative complications,pulmonary complications,extubation time,PACU stay time,postoperative ICU stay time and postoperative hospital stay days in patients with esophageal cancer.Enhance the patient's postoperative recovery.