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Association between thoracic epidural block and major complications after pleurectomy/decortication for malignant pleural mesothelioma under general anesthesia
  1. Ken Onoe1,
  2. Hiroki Ogata1,
  3. Takuma Okamoto1,
  4. Hiroai Okutani1,
  5. Ryusuke Ueki1,
  6. Nobutaka Kariya1,
  7. Tsuneo Tatara1,
  8. Masaki Hashimoto2,
  9. Seiki Hasegawa2,
  10. Yuka Matsuki3 and
  11. Munetaka Hirose1
  1. 1Department of Anesthesiology and Pain Medicine, Hyogo Medical University, School of Medicine, Nishinomiya, Hyogo, Japan
  2. 2Department of Thoracic Surgery, Hyogo Medical University, School of Medicine, Nishinomiya, Hyogo, Japan
  3. 3Department of Anesthesiology and Reanimatology, Faculty of Medical Sciences, University of Fukui, Eiheiji-cho, Fukui, Japan
  1. Correspondence to Munetaka Hirose, Department of Anesthesiology and Pain Medicine, Hyogo Medical University, School of Medicine, Nishinomiya, Hyogo, Japan; mhirose{at}hyo-med.ac.jp

Abstract

Introduction A curative-intent surgical procedure, pleurectomy/decortication, for malignant pleural mesothelioma is accompanied by a high incidence of major postoperative complications. Although epidural block, which suppresses nociception during and after surgery, reportedly has both benefits and disadvantages in terms of outcomes after thoracic surgery for other diseases, the effects of epidural block on major complications after pleurectomy/decortication have not been evaluated. The aim of this study was to evaluate the association between epidural block and major postoperative complications following pleurectomy/decortication.

Methods In a single-institutional observational study, consecutive adult patients undergoing pleurectomy/decortication under general anesthesia were enrolled from March 2019 to December 2021. Multivariable logistic regression analysis was performed to determine the association between perioperative variables and major complications. Next, patients were divided into two groups: general anesthesia with and without epidural block. Incidences of major postoperative complications, defined as Clavien-Dindo grades≥III, were compared between groups.

Results In all patients enrolled with American Society of Anesthesiologists (ASA) physical status II or III (n=99), general anesthesia without epidural block was identified as a sole risk factor for major complications among perioperative variables. The incidence of major complications was 32.3% (95% CI 19.1% to 49.2%) in patients with epidural block (n=34), which was significantly lower than 63.1% (95% CI 50.9% to 73.8%) in patients without epidural block (n=65). In sensitivity analysis in patients with ASA physical status II alone, the same results were obtained.

Conclusion Epidural block is likely associated with reduction of the incidence of major complications after pleurectomy/decortication for malignant pleural mesothelioma under general anesthesia.

  • analgesia
  • outcome assessment, health care
  • postoperative complications
  • regional anesthesia

Data availability statement

Data are available upon reasonable request. Not applicable.

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Data availability statement

Data are available upon reasonable request. Not applicable.

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Footnotes

  • Correction notice This article has been corrected since it published Online First. The results section of the abstract has been amended.

  • Contributors Data acquisition, data analysis and guarantor responsible for the overall content: MuH. Supervision of data analysis: KO, HO, TO and YM. Interpretation of study results: HO, RU, NK, TT, MaH and SH. Manuscript revision and approval: all authors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.