EXPERIENCE OF USING EPIDURAL ANESTHESIA IN ONCOSURGERY: A CLINICAL CASE

Abstract

Relevance: Surgical intervention is the most revolutionary method in the complex specific therapy of malignant neoplasms. Oncosurgical operations are among the most traumatic; the volume of surgical intervention depends on the stage of the tumor process and its prevalence, the presence of metastases, germination in neighboring tissues and organs, and concomitant diseases. Particular importance is attached to the anesthetic management of the perioperative period. Regional anesthesia is practically not used for several reasons in oncosurgical reconstructive and plastic interventions on the abdominal organs. First, the anesthetist’s qualification plays a role in choosing the anesthesia method, especially when performing high epidural anesthesia, which is technically challenging. The emergence of highly effective anesthetics and high-quality sets for epidural anesthesia has significantly expanded the scope of this type of anesthesia in oncosurgery. This study aimed to demonstrate the possibilities and advantages of epidural anesthesia in the perioperative period using the described clinical case as an example. Methods: Patient N. was admitted to the clinic for surgical treatment for a malignant neoplasm of the transverse colon without clinical signs of obstruction of the lumen of the large intestine. She underwent laparotomy, subtotal colectomy with anastomosis, resection of the omentum, and lymph node dissection. Epidural anesthesia with catheterization of the epidural space and administration of ropivacaine and morphine was used as an anesthetic aid. Results: Adequate pain relief, relaxation, the absence of clinically significant autonomic reactions in the intraoperative period, and adequate pain relief without narcotic analgesics in the postoperative period were achieved. The patient was activated on days 3-5 after surgery. Subjectively, the patient emphasized the comfortable course of the perioperative period. Conclusion: Thus, our experience of using regional (epidural) anesthesia in oncosurgery as an isolated method of anesthesia, subject to technically competent and accurate execution of the procedure, allows us to recommend it as a reasonable alternative or a component of generally accepted traditional general anesthesia to reduce the risk of anesthesia, adequate and effective anesthesia in the perioperative period and optimization of economic and logistical costs in the postoperative period.