The Impact of Total Intravenous Propofol Anaesthesia versus Sevoflurane Anaesthesia on Perioperative Pain in Patients Undergoing Colonic Cancer Surgery

Background: Cancer colon is one of the most common malignancies. After colon cancer surgery patients may experience severe pain. Several studies have reported that a significant decrease in postoperative pain with propofol while other studies have showed this effect was not significant. Aim: Our goal was to assess the effect of combined epidural anaesthesia either with propofol or sevoflurane on intraoperative fentanyl consumption and postoperative pain in patients undergoing open surgical resection of colon cancer. Patients and Methods: 48 adult patients suffering from cancer colon scheduled for open surgical resection randomly allocated either to receive epidural-propofol by total intra venous anaesthesia (TIVA) (n = 24) or epidural-sevoflurane anaesthesia (n = 24), intraoperative heart rate and fentanyl consumption and postoperative pain score (verbal analogue scale, 0 - 10) were recorded. Results: In our study we found that the intensity of postoperative pain was low in all patients and the propofol based anaesthesia had relatively lower pain scores up to 24 hrs postoperatively in comparison to sevoflurane based anaesthesia, intraoperative fentanyl consumption was lower with sevoflurane and heart rate lower with propofol group. Conclusions: we recommend that use of multimodal analgesia decrease postoperative pain in all cancer colon patients undergoing open surgery who anaesthetized with either propofol or sevoflurane. Also use of propofol showed better analgesic outcomes postoperatively.

Effect of Bilateral Ultrasound-Guided Quadratus Lumborum Block versus Lumbar Epidural Block on Postoperative Analgesia following Major Lower Abdominal Cancer Surgery

Background: Poor postoperative pain control leads to longer postoperative care, longer hospital stay and decreased patient overall satisfaction. Aim: To compare the efficacy and safety of bilateral ultrasound-guided quadratus lumborum block versus lumbar epidural block on the management of postoperative pain following major lower abdominal cancer surgery. Methods: The study was a double-blinded, and randomized study, conducted in South Egypt Cancer Institute, Assiut University, Egypt. It included cancer patients scheduled for major lower abdominal cancer surgery in the period from 2019 to 2020. They were divided into two groups: Group Ι received pre-emptive ultrasound-guided Quadratus Lumborum Block (QLB) with 25 mL of 0.25% bupivacaine on each side of the abdominal wall before induction of General Anesthesia (GA), and Group II received pre-emptive lumbar epidural block with 15 mL of 0.25% bupivacaine before induction of GA. VAS score, and time of the first analgesic request and postoperative total analgesic consumption were evaluated. Results: Sixty patients were included in our study. VAS score at rest was comparable between both studied groups in the first 6 h. At 8 and 10 h, Group II had a significantly higher VAS score at rest (P < 0.001 and 0.026 respectively). Meanwhile, at 12 h, patients in Group I had a significantly higher VAS score (P = 0.026). Mean time of the first request for rescue analgesia was significantly prolonged in Group I (13.27 ± 2.38 hrs.) compared to Group II (10.20 ± 1.42 hrs.) (P < 0.001) respectively, mean total morphine consumption, over the first 24 hours postoperatively, was significantly lower in Group I (5.17 ± 1.32 mg) than in Group II (7.33 ± 1.45 mg) (P < 0.001). A larger number of patients in Group II had nausea at different time points postoperatively than in Group I (P < 0.001), but no significant difference was observed between both studied groups regarding the incidence of vomiting. Limitation: Small sample size and shorter period for postoperative follow-up. Conclusions: Management of postoperative pain following major lower abdominal cancer surgery with US-guided QLB was associated with the reduction in the total analgesic consumption and delayed the first request of analgesia as compared to lumbar epidural block technique.