Thoracic Epidural Versus General Anaesthesia for MRM Surgeries

Background : General anaesthesia is still the preferred technique amongst many practitioners for oncologic breast surgeries. However the TEA technique has a lot of advantages over the conventional GA technique. Objective: We attempted to evaluate the two techniques of anaesthesia for MRM surgeries. Materials and Method: Sixty ASA I-II patients undergoing MRM were randomly assigned to two study groups of 30 patients each. In the TEA group (group T), an epidural catheter was inserted at T7-T8 level, and 8-10 ml of 0.5% bupivacaine was titrated and administered. GA (group G) was induced with 2mg/kg of propofol and was maintained with Isoflurane, intermittent inj. Vecuronium and 70% N2O in oxygen. The authors evaluated the adequacy of anesthesia, surgical condition, post anesthetic recovery, post anesthetic analgesia and patients' satisfaction. Results: The intra operative haemodynamics was comparable in between the two groups. The incidence of nausea and vomiting was significantly lower in the TEA group (16.5% in group T and 39.6% in group G , P = 0.02). The mean immediate VAS score was also lower in TEA group ( group T =2.4 , group G =5.8,P = 0.001). Aldrete recovery score was 9/10 in 1 st hr in a significant proportion in the TEA group (89.1% in group T v/s 59.4% in group G , P = 0.003). Patient satisfaction was significantly higher. The surgeons were however satisfied with both the methods. Conclusion: Use of thoracic epidural technique as a sole anaesthetic technique for MRM surgeries provides adequate operating conditions, better side effect profile, better pain management and patient satisfaction.