Background and Aims: Cancer and its therapy may impact the epidural insertion decision-making, secondary to cancer coagulopathy, chemotherapy-induced thrombocytopenia, cancer thrombosis and spine metastasis in oncosurgical patients. Epidural is the cornerstone for post-operative analgesia in major cavitary oncosurgical procedures. The authors aimed for the incidence of epidural omission and analyse the factors for the same in adult onco-surgical patients. Methods: Patients who underwent major gastrointestinal, hepatobiliary, genitourinary and thoracic elective open onco-surgeries were postoperatively screened for epidural omission over 16 months. Patients who underwent gynaecological onco-surgery, minimally invasive surgery and in whom epidurals were attempted but abandoned were excluded. The factors for epidural omission were ascertained from the acute pain services form and attending anaesthesiologists. Data regarding pre-operative laboratory investigations, chemotherapy and metastasis were collected for the analysis. Results: In this study, 2019 patients were screened. Epidural was omitted in 112 patients (7.41%). The most frequent reasons for the same were pre-operative coagulopathy (raised activated partial thromboplastin time aPTT in 46 patients, thrombocytopenia in 23 patients and raised international standardised ratio in 17 patients). Other frequent factors were intraoperative conversion of minimally invasive to open surgery and surgery under vascular cover with resultant need for post-operative anticoagulants. Conclusion: Cancer-related coagulopathy and the magnitude of surgical resection were the top five factors responsible for non-insertion of pre-operative epidural in adult onco-surgical patients. Pre-operative evaluation of coagulation parameters, including aPTT, is imperative in patients posted for major onco-surgeries.
Wajekar et al. (2026) studied this question.