Thoracic epidural anesthesia does not improve the incidence of arrhythmias after transthoracic esophagectomy

Objective: The incidence of arrhythmias related to an esophagectomy is high, and its clinical significance has been well accepted. Thoracic epidural anesthesia (TEA) can modulate the sympathetic tone and neuroendocrine responses associated with major operation. This study was aimed to evaluate the effects of TEA on the incidence of arrhythmias in transthoracic esophagectomy patients. Methods: The records of 185 patients who underwent the Ivor-Lewis operation between 2001 and 2004 by the same operator were reviewed. The patients were divided into three groups. Group 1 (n=58) received post-operative intravenous patient-controlled analgesia without TEA. Group 2 (n=55) received postoperative epidural patient-controlled analgesia using local anesthetics. The patients of group 3 (n=72) were anesthetized intra-operatively by the combination technique of thoracic epidural bupivacaine and inhalation agents, and post-operative pain control was done in the same way with group 2. Results: Arrhythmias occurred 29.3, 50 and 29.2% in groups 1, 2 and 3, respectively. There were no statistical differences in the incidences of arrhythmias among the three groups. Conclusions: This result shows that TEA was not beneficial to reduce the incidence of arrhythmias in the transthoracic esophagectomy patients.