Prophylactic use of intraoperative Nor-epinephrine infusion vs. bolus doses of Ephedrine and Phenylephrine in patients undergoing colorectal surgery under combined general and epidural anaesthesia for enhanced recovery after surgery. (ERAS)

Abstract

Introduction: Enhanced recovery after surgery (ERAS) has become an important focus of perioperative management after colorectal surgery. Maintenance of arterial blood pressure during combined general and epidural anesthesia is essential for organ perfusion and has been found as an important prognostic factor for enhanced postoperative recovery. Aim: To compare Norepinephrine infusion with ephedrine / phenylephrine boluses to maintain stable blood pressure and enhance postoperative recovery. Methods: Patients with physical status ASA I and II of either sex admitted for colorectal surgery were randomized into two groups. Group A: Nor-epinephrine group and Group B: Ephedrine/Phenylephrine group. After induction of general anesthesia Group A patients received norepinephrine infusion at a dose to keep mean arterial pressure (MAP) more than or equal to 80 mmHg after epidural anesthesia was activated with 10 ml of 0.25% ropivacaine whereas Group B patients received Ephedrine / Phenylephrine stat doses in case of hypotension (MAP < 80 mmHg) during intraoperative period. Intraoperative hemodynamics and fluid input output were recorded in both groups. Post operative hemodynamics, renal function, oral feeding and early mobilization were compared in both the groups as indicators of enhanced recovery. Results: Prophylactic use of Norepinephrine infusion in patients undergoing colorectal surgery under combined epidural and general anesthesia was found to produce more stable intraoperative blood pressure compared to the use of ephedrine/phenylephrine boluses. Fluid requirement in group A during the procedure was less as compared to group B and the urine output during intraoperative period was better in patients receiving nor epinephrine infusion . Postoperative complications were lower in patients receiving norepinephrine infusion. Conclusion: Prophylactic use of nor epinephrine infusion to prevent intraoperative hypotension in patients undergoing colorectal surgery under combined epidural and general anesthesia was found to produce more stable intraoperative blood pressure and better postoperative course .