The Contribution of Thoracic Epidural Analgesia in Major Urological Surgery

Introduction: Total cystectomy with urinary diversion is a major urological surgery associated with high perioperative morbidity and mortality. The placement of anesthesia or epidural analgesia (APD) is a very common practice in many surgical procedures, especially in urologic surgery. Our objective was to assess the value of thoracic epidural analgesia in terms of the delay in resumption of transit and its impact on postoperative rehabilitation during heavy urological surgery. Material and method: Retrospective observational study carried out at the IBN TOFAIL Hospital in Marrakech over a period of 2 years. Any patient requiring total cystectomy by laparotomy or laparoscopy for bladder cancer was included. All patients were offered epidural analgesia (“APD” group). The patients who could not benefit from it constituted the control group "T". The descriptive analysis consisted in the calculation of the absolute and relative frequencies for the qualitative variables, and of the positioning and dispersion parameters for the quantitative variables (mean, standard deviation). The normal distribution of the variables was studied by the Kolmogorov-Smirnov test. In bivariate analysis, the comparison of qualitative variables made use of Pearson's Chi2 statistical test and Fisher's test if necessary. Student's t test and Mann Whiteny test. The significance level was retained for a p <0.05. Statistical analysis was performed using SPSS software version 19.0. Results: Sixty three patients spread to the inclusion criteria were collected during the study period, divided into 27 patients in the "control" group and 33 patients in the "APD" group. The most affected age group was that of 35 years and 86 years with an estimated average of 60.25 years ± 10.75. Smoking was a risk factor for bladder cancer in 75% of cases, with an average of 20PY. The most used surgical technique was Bricker in 50% of cases, followed by enlargement enterocystoplasty in 33.3% and then bilateral .........