Comparative Study between Continuous Epidural Infusion vs Intravenous Patient Controlled Analgesia (PCA) to Control Post-Operative Pain after Cytoreductive Surgery Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Objective: This study was conducted to compare two methods of post-operative analgesia after cytoreductive surgery and HIPEC procedure; Continous Epidural Infusion VS Intravenous Patient Controlled Analgesia (PCA). Patients Methods: twenty intra-abdominal cancer patients undergoing cytoreductive surgery and HIPEC procedure in National Cancer Institute (NCI) from December 2010 till July 2011are randomly classified into two groups; group E (epidural) who received thoracic epidural analgesia bolus 6 ml of bupivacaine 0.25% followed by continous epidural infusion of bupivacaine 0.125% + fentanyl 2/µg/ml at a rate of 6-10 ml/hour + epidural bolus of 30µg fentanyl in 6ml volume on demand to keep VAS less than 4/10, and group I (TV PCA) who received continuous IV fentanyl infusion at a rate of 30 µg/hour + IV bolus of fentanyl 50/jg with lockout interval of 1 hour by PCA to keep VAS less than 4/10. In both groups we measured total 48hrs fentanyl consumption in micrograms, total post-operative ICU stay in days, and post-operative mechanical ventilation in hours, in addition to major side effects in both groups. Results: We found that total 48 hours fentanyl consumption in micrograms was significantly lower in Group E (750 /µg) than Group I (1730 /µg) (p 0.001), The total post-operative ICU stay in days was significantly lower in Group E (4.5 days) than Group I (7.5 days) (p 0.001), total post-operative mechanical ventilation in hours was significantly lower in Group E (5.30 hours) than Group I (9.20 hours) (p 0.001 ).There was no recorded marked side effects in both groups. Conclusion: We concluded that continous epidural infusion is an effective method of analgesia after the major cytoreductive surgery and HIPEC procedure