Combined regional-general anesthesia: evaluation of remifentanil based general anesthesia and postoperative epidural analgesia.

OBJECTIVES: To evaluate whether remifentanil based general anesthesia combined with epidural analgesia for postoperative pain, has any advantages with respect to consumption of drugs, blood loss, quality of pain control, hemodynamic profile, in major abdominal surgery, as compared to other combined techniques.

METHODS: A retrospective study based on chart reviews of patients who have undergone colectomy, radical cystectomy and radical prostatectomy over one year period in our Institution, operated under combined regional-general anesthesia. Twenty-six patients were analyzed and were divided into three groups according to the type of anesthesia received. Group A: combined general-epidural for per-operative and postoperative pain (10 patients). Group B: combined spinal-general anesthesia (8 patients) post-operative analgesia consisted of parenteral mepiridine and paracetamol. Group C: remifentanil based general anesthesia followed by epidural for postoperative analgesia (8 patients).

RESULTS: The demographic data, age and M/F distribution were comparable in the three groups. The remifentanil group showed less utilization of muscle relaxant (Cisatracurium) with respect to other groups (p < 0.001). The amount of intraoperative blood loss was not significantly different among the three groups. The efficacy of the postoperative epidural analgesia was demonstrated by the minimal utilization of analgesics (p < 0.05 and 0.01) in group A and C as compared to group B. In the group of remifentanil, the blood pressure was more stable and maintained at a systolic of 80-100 mmHg as compared to initial hypotension mainly in group C.

CONCLUSION: The use of remifentanil based general anesthesia offers the advantage of non-accumulation of drugs and hemodynamic stability. Post-operative analgesia can be provided by epidural route which proved to be satisfactory in the remifentanil group. The effect on blood loss was not conclusive in this study.