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Combined Lumbar Spinal and Thoracic High-Epidural Regional Anesthesia as an Alternative to General Anesthesia for High-Risk Patients Undergoing Gastrointestinal and Colorectal Surgery
World Journal of Surgery, 07/20/09

Skipworth J et al. – This study supports the role of regional anesthetic techniques, combined with targeted, minimally invasive surgery—particularly for the management of high–risk patients presenting in the emergency setting.

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James Skipworth, 07/21/09

We undertook a prospective review of the use of regional anesthesia (thoracic epidural and lumbar subarachnoid block) in 13 high-risk (ASA 3 or 4) patients undergoing targetted minimally-invasive gastrointestinal/colorectal surgical procedures. The overall median patient age was 86 years and ten (76.9%) patients presented as emergencies. All patients subjectively rated their postoperative pain relief as effective. The 30-day mortality was 2; however, both of these patients refused initial treatment. Only one patient required delayed ITU admission for respiratory support (CPAP). There were two minor and two major early complications and only one delayed complication to date. Median length of stay was 7 days. These patients demonstrated early postoperative recovery, with effective analgesia, no requirements for intubation, and lower morbidity and mortality rates than similar studies of high-risk patients who underwent procedures using general anesthesia.

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