Cytoreductive surgery combined with heated intraperitoneal chemotherapy (HIPEC) has been improving prognosis of patients with peritoneal carcinomatosis (ou patients with peritoneal carcinomatosis’ prognosis). This procedure is an anesthetic challenge not only for hemodynamic stabilization during surgery but also for postoperative analgesia. Since is a very painful surgery, epidural analgesia presents itself as the recommended technique. However, HIPEC’s influence on coagulation and hematological profile increase epidural hematoma or abcess risk which may conditionate ? epidural’s analgesia role.
Therefore, our aim is to evaluate safety and efficacy of epidural analgesia on (?) HIPEC.
Retrospective observational study from June 2016 to June 2017, through consulting of electronic clinical process and Acute Pain Unit (APU) database. Included patients under general anesthesia and epidural analgesia protocol (PCEA2). General anesthesia was induced with intravenous fentanil, propofol and rocuronium. After induction, invasive blood pressure was monitored. Anesthesia was maintained with desflurane, rocuronium and ropivacaine (2mg/mL) according with patient’s requirement. Quimioperfusion lasted 60 minutes. The neuromuscular blockage was reverted with sugammadex. During postoperative period, all patients were daily evaluated by APU. Pain was evaluated according to a qualitative scale: good analgesia when no or mild pain were recorded, reasonable analgesia if moderate pain, bad analgesia when severe ou unbearable pain.
47 patients were included, average age of 57, 72% were female, 83% ASA2 and 17% ASA3. Surgery lasted in mean 411 minutes. Mean endovenous fentanil 0.20 mg, epidural ropivacaine 52mg. 44.6% needed vasopressor during surgery. Mean blood loss estimated on 300 mL (only 3 patients with blood transfusion). Nausea and vomiting (NV) prophylaxis in 93.6%. Mean duration of epidural cateter: 6 days. Only 23% went to ICU. Mean hospital stay: 14 days. Complications on 55.3% (NV 19.1%, hypotension 12.8%, itching 8.5%, parestesias 6.4%, accidental dislodgments of epidural cateter 6.4%,thrombocytopenia 2.1%). Quality of analgesia at rest/on movement: good analgesia on 97.8%/80.8%, reasonable 2.2%/19.2%.
With no major complications, our experience suggests that epidural analgesia is a safe, weel tolerated and effective tecnhique. The higher incidence of NV and hypotension is due to the complexity of the surgery. Close monitoring is recommended in order to achieve satisfactory analgesia and to reduce the incidence of complications.


07 / Epidural Analgesia in the cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy – a risky practice?