A comparative study to evaluate thoracic epidural anaesthesia (TEA) and general anaesthesia (GA) for MRM surgeries

Abstract

Background: General anaesthesia is still the preferred technique amongst many practitioners for oncologic breast surgeries. However the TEA technique has a lot of advantages over the conventional GA technique. Aim: We attempted to evaluate the two techniques of anaesthesia for MRM surgeries. Materials and method: Sixty ASA I-II patients undergoing MRM were randomly assigned to two study groups of 30 patients each. In the TEA group( group T), an epidural catheter was inserted at T7-T8 level, and 8-10 ml of 0.5% bupivacaine was titrated and administered.GA (group G) was induced with 2mg/kg of propofol and was maintained with Isoflurane ,intermittent inj. Vecuronium and 70% N2O in oxygen. The authors evaluated the adequacy of anesthesia, surgical condition, post anesthetic recovery, post anesthetic analgesia and patients’ satisfaction. Results: The intra operative haemodynamics was comparable in between the two groups. The incidence of nausea and vomiting was significantly lower in the TEA group ( 16.5% in group T and 39.6% in group G , P = 0.02).The mean immediate VAS score was also lower in TEA group ( group T =2.4 , group G =5.8,P = 0.001).Aldrete recovery score was 9/10 in 1st hr in a significant proportion in the TEA group (89.1% in group T v/s 59.4% in group G , P = 0.003).Patient satisfaction was significantly higher. The surgeons were however satisfied with both the methods. Conclusion: Use of thoracic epidural technique as a sole anaesthetic technique for MRM surgeries provides adequate operating conditions, better side effect profile, better pain management and patient satisfaction.