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Epidural anaesthesia with bupivacaine does not cause increased oedema in small gut anatomoses in pigs

2004; Lippincott Williams & Wilkins; Volume: 21; Issue: 11 Linguagem: Inglês

10.1097/00003643-200411000-00006

1365-2346

Anette Marianne Fedder, Rolf Dall, Søren Laurberg, S. Å. Rodt,

Enhanced Recovery After Surgery

Background and objective: Epidural analgesia is widely used for abdominal surgery due to the properties of 'stress-free' anaesthesia and superior pain control. Nevertheless, sympathomimetics are known to antagonize inflammation. The present study was performed to investigate if epidural local anaesthetics caused increased local oedema formation. Methods: Thirty Dansk Landrace pigs were randomized into three groups: epidural bupivacaine, epidural morphine or intravenous (i.v.) fentanyl. All animals were anaesthetized with isoflurane and i.v. midazolam and received an identical fluid regimen. Six small bowel resections were performed over a 3-h period and during the following 3 h the anastomoses were resected. Primary end-points were water content in small bowel and mesentery samples before and after gut anastomosis, lymph flow and urine production. Results: The water content in the small bowel samples was not changed by surgery or by the different anaesthetic protocols. In the mesenteric tissue, there was a highly significant increase in water content of the post-anastomotic samples compared to pre-anastomotic samples (P < 0.001) and a significant time treatment interaction was revealed (P < 0.05) suggesting an increase in oedema formation in the epidural local anaesthetic group. Lymph flow did not change during the experiments and there were no significant differences between the groups (P = 0.80). The mean total urine output was 44% higher in the epidural morphine group compared to the local anaesthetic group (P = 0.17). Conclusions: Surgery did not increase gut wall water content, but acute oedema formation resulted in the peri-resectional mesenterial tissue, more prominently so in the bupivacaine group.