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ORIGINAL ARTICLE
Year : 2020  |  Volume : 36  |  Issue : 2  |  Page : 182-186

Cervical epidural analgesia combined with general anesthesia for head and neck cancer surgery: A randomized study


1 Department of Anesthesia, Critical Care and Pain Medicine, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
2 Department of Anesthesiology and Critical Care, Hamdard Institute of Medical Sciences and Research, New Delhi, India
3 Department of Anesthesia, Critical Care and Pain Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India

Correspondence Address:
Dr. Anjali Kochhar
D262, Narmda Apartments, New Delhi - 110 019
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joacp.JOACP_72_19

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Background and Aims: The role of cervical epidural analgesia in head and neck cancer surgery is not fully explored. The aim of this study was to evaluate cervical epidural analgesia in terms of opioid and anesthetic requirements and stress response in patients undergoing head and neck cancer surgery. Material and Methods: After institutional ethical committee approval and written informed consent, 30 patients undergoing elective head and neck cancer surgery were randomized into two groups: Group E (cervical epidural analgesia with general anesthesia), and group G (general anesthesia alone). In group E, an 18 gauge epidural catheter was placed at cervical (C) 6 – thoracic (T) 1 level. After test dose, a bolus of 10 ml of 0.2% ropivacaine was given followed by continuous infusion. Technique of general anesthesia and post-operative management was standardized in both the groups. Opioid and anesthetic drug requirement was observed. Blood glucose and serum cortisol levels were measured at baseline; post-incision and after surgery. Results: There was significant reduction in the requirement of morphine (P < 0.001), isoflurane (P = 0.004) and vecuronium (P = 0.001) in group E. Post-operative, blood glucose and serum cortisol levels were significantly reduced (P = 0.0153 and 0.0074, respectively). Early post-operative pain was reduced with the lesser requirement of post-operative morphine. Conclusions: The use of combined cervical epidural analgesia with general anesthesia reduces opioid, anesthetic drug requirement and stress response as compared to general anesthesia alone in patients undergoing head and neck cancer surgery.


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