Effects of Epidural Anesthesia on Quality of Life in Elderly Patients Undergoing Esophagectomy

Abstract

Continuous epidural analgesia during surgery can effectively inhibit surgically induced stress and inflammatory response. It also spares opioid use and reduces postoperative pain. This study explored the effects of intraoperative epidural anesthesia on quality of life and central nervous system injury in elderly patients after esophagectomy. Elderly patients who were scheduled for thoracoscopic-laparoscopic esophagectomy were eligible for this randomized controlled study. The patients in the experimental group received general anesthesia combined with epidural anesthesia, while the patients in the control group received only general anesthesia. At the end of surgery, all patients received the same epidural analgesia program before extubation. Health-related quality of life (HRQoL) was assessed using the European Organization for Research and Treatment of Cancer (EORTC) Quality of life Questionnaires (QLQ)-C30 and QLQ-OES18 questionnaires. Two HRQoL questionnaires were filled out before surgery, on day 7 and after the third month postoperatively. The Montreal Cognitive Assessment and serum S100β level were also evaluated at baseline and on postoperative day 7. Compared with the group without intraoperative epidural anesthesia, the epidural anesthesia group had better quality of life scores particularly in the social, emotional, and global health domains. The symptoms of nausea, constipation, sleep disorders, dysphagia, reflux, pain, and cough difficulty were less severe. In addition, the S100β content of peripheral blood was also lower on postoperative day 7 (1199.8 pg/mL vs 1341.2 pg/mL, P < 0.001). There was no significant difference in Montreal Cognitive Assessment scores between the 2 groups. Intraoperative epidural anesthesia may improve the quality of life after esophagectomy in elderly patients, and reduce the neuroinflammatory response, compared with the patients receiving general anesthesia only.

Keywords: Early rehabilitation; Intraoperative epidural anesthesia; Neuroinflammation; Postoperative quality of life.