Thoracic epidural anesthesia and analgesia for cancer surgery: The importance of the anesthetic technique

Major palliative or curative surgery in patients with malignancies can involve significant postoperative cardiac or pulmonary morbidity and result in severe postoperative pain. There is now a body of evidence that supports the use of combined epidural and general anesthesia for patients undergoing these prolonged surgical procedures of the abdomen and/or thorax. The intraoperative management of both components of the anesthetic, providing a continuous and adequate sensory blockade with local anesthetics, while limiting the inhalational and intravenous anesthetics to the minimum necessary for patient comfort may be as important as the choice of the anesthetic technique per se. Although, well-designed clinical studies are necessary to confirm this hypothesis, a recent pilot study has shown that this approach has resulted in a shorter hospitalization course without an increase in the incidence of complications or jeopardizing patient comfort. Copyright © 2000 by W.B. Saunders Company