Thoracic epidural anaesthesia for major abdominal surgeries: experience in private hospital setting in Uyo, South-South Nigeria

Background: Thoracic epidural anaesthesia (TEA) has many benefits over general anaesthesia in major abdominal surgeries including avoidance of endotracheal intubation. Aims: To evaluate the feasibility of TEA for major abdominal surgeries in the private hospital setting. Patients and methods: This was a retrospective study of all major abdominal surgeries performed under TEA in two private hospitals in Uyo, Akwa Ibom State, Nigeria over a two-year period. All thoracic epidural anaesthesia was performed under aseptic conditions at the T8/9, T9/10, or T10/11 interspinous space using a size 18G Tuohy epidural needle and catheter inserted as appropriate. A test dose of 3 ml of 1% lidocaine with adrenaline was used in all patients, after which a loading dose of 10–15 ml of 2% lidocaine with adrenaline was injected at 5 ml every 5 minutes till a block height of approximately T4–L1 was obtained. Anaesthesia was maintained with 5 ml of 2% lidocaine with adrenaline every 45 minutes till the end of surgery. The operative condition was assessed on the basis of sedation and analgesic requirement, as well as response to mesenteric traction. The pulse rate, blood pressure and oxygen saturation were monitored throughout the procedure and recorded. Data were obtained from the patients’ folders and operation register. Information included: age, gender, ASA status, diagnosis and type of surgery performed. Data analysis was performed using SPSS®, version 16. Results: Twelve patients underwent major abdominal surgeries under TEA. The mean age (range) was 49.58 (20–78) years, with a male to female ratio of 1:1.4. TEA was adequate in 10 (83.3%) patients, while two (16.7%) patients developed total spinal anaesthesia and were successfully resuscitated and their surgeries completed under general endotracheal anaesthesia. Conclusion: TEA for major abdominal surgeries is feasible. However, careful patient selection, a meticulous approach and preparation for resuscitation is required to prevent and manage complications.