Comparison of postoperative pulmonary functions and outcomes in patients undergoing major abdominal surgeries between general anaesthesia with thoracic epidural and thoracic continuous spinal anaesthesia: An exploratory randomised study.

Background and Aims: Thoracic continuous spinal anaesthesia (TCSA) avoids airway instrumentation and mechanical ventilation and may provide better postoperative pulmonary outcomes compared to general anaesthesia (GA) with thoracic epidural analgesia (TEA) for patients requiring laparotomy. The study compared postoperative pulmonary functions and outcomes between these two anaesthesia techniques. Methods: Sixty adults were randomly assigned to Group GA+TEA or Group TCSA. In Group GA+TEA, the TEA was secured through the T9-T10 level, followed by GA. A 25-G catheter was placed at the same level in Group TCSA, and they received all preservative-free drugs (0.5% plain bupivacaine with 0.25 mg/kg ketamine and 0.03 mg/kg midazolam) to achieve a sensory block from T4 to L1. The primary outcome assessed was peak expiratory flow rate (PEFR) over the 72 h postoperative period. The secondary outcomes assessed were breath-holding time (BHT), lung atelectasis, and change in transdiaphragmatic excursion. The two-sided Student t-test, Mann-Whitney test, and Chi-squared test were used to analyse the data. Results: The PEFR was reduced in both groups from baseline (P < 0.001), with no difference between them (P = 0.498). However, Group TCSA showed significantly better outcomes concerning BHT on postoperative days (POD) 1 and 2 (P = 0.048 and P = 0.005, respectively), reduced lung atelectasis at 1 h postoperatively (P = 0.03), and greater diaphragmatic excursion at 1 h, POD 1 and 2 (P < 0.001). Conclusion: In patients undergoing major abdominal surgery, the PEFRs during the postoperative period were comparable for GA with thoracic epidural versus thoracic continuous spinal anaesthesia.