Background: Major Upper gastrointestinal cancer surgeries induce postoperative pain, that if not controlled may
cause various organ dysfunctions and prolonged hospital and ICU stay. Thus an appropriate pain therapy to those
patients must be applicated.
Objective: To investigate the effects of Continuous intra and post operative thoracic epidural Fentanyl–
bupivacaine infusion in patients undergoing Major Upper gastrointestinal cancer Surgery.
Methods: 60 patients (ASA II) of either sex were scheduled for elective Upper gastrointestinal cancer surgeries.
Patients were allocated randomly into two groups (30 patients each) to receive, beside GA: continuous intra and
post -operative intravenous infusion with fentanyl for 72 hours post-operatively (control group) or continuous intra
and post -operative epidural infusion with bupivacaine 0.125% and fentanyl (TEA group) for 72 hours postoperatively. Intra-operative haemodynamics and fluid shift (blood loss, blood transfusion and colloid transfusion)
were recorded. Postoperative pain was assessed over 72 h using visual analogue scale (VAS). And post-operative
haemodynamics, sedation score and overall fentanyl consumption were recorded. Any concomitant side effects like
nausea; vomiting, pruritus or respiratory complications were recorded postoperatively.
Results: There was a significant decrease in pain scores (p. value =0.049*) with less sedating effect (p. value
0.01*) especially in early postoperative hours in TEA group in comparison to control group. Intra-operative
haemodynamics (MAP and HR) were increased not markedly but significantly in control group with p. value of
mean MAP=0.018* and p value of mean HR=0.016* respectively.
Postoperative haemodynamics (MAP and HR) and also Intra-operative fluid shift (blood loss, blood transfusion
and colloid transfusion) were comparable in both groups.
Conclusion: Continuous intra and post operative thoracic epidural Fentanyl–bupivacaine infusion was associated
with decreased in fentanyl consumption, better pain relief, less sedating effect and optimized peri-operative
haemodynamics than continuous perioperative fentanyl intravenous infusion in patients undergoing Major Upper
gastrointestinal cancer Surgery.