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474 ERAS protocols in gynaecological oncology. Should we include thoracic epidural analgesia?
  1. A Pandraklakis1,
  2. A Prodromidou1,
  3. T Lappas2,
  4. E Stamatakis2,
  5. D Valsamidis2,
  6. D Haidopoulos1,
  7. A Rodolakis1 and
  8. N Thomakos1
  1. 1Athens, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece., Athens, Greece
  2. 2Department of Anesthesiology and Pain Management, ‘Alexandra’ General Hospital of Athens, Athens, Greece


Introduction/Background*Enhanced recovery after surgery (ERAS) pathways aim to improve the perioperative practice ending in a shorter length of stay with less postoperative complications. Although thoracic epidural analgesia (TEA) is included in ERAS guidelines of other specialties, it is not included in ERAS guidelines in gynaecological oncology. We aim to provide further information in the use of TEA in ERAS protocols in gynaecological oncology.

Methodology A retrospective analysis of a prospectively maintained database of patients who underwent intermediate to high complexity surgery from January 2020 to March 2021 due to gynecological malignancy. The ERAS protocol was followed and patients with compliance rates >75% who received postoperative (PO) analgesia through thoracic epidural catheter as part of multimodal analgesia (TEA group) versus those who did not (non-TEA group) were compared. Mobilization, length of stay (LOS), and postoperative pain were considered the primary outcomes of the study

Result(s)*A total of 130 patients (87 in TEA group versus 43 in non-TEA group). Mean visual analog scale (VAS) pain scores at both the day of surgery and PO day 1, were significantly lower in TEA group compared to non-TEA (3.74 vs 4.67, p<0.0001 and 3.30 vs 4.14, p<0.0001, respectively). Mobilization rates were significantly higher in TEA group versus non-TEA (93% vs 62%, p<0.0001). Mean opioid use was significantly higher in non-TEA group (p<0.0001), while nausea rates were significantly reduced in TEA patients (p=0.021). No difference in LOS was observed among the two groups (4.18 vs 4.40, p=0.995) same as in complication rates.

Conclusion*Although TEA is not included in ERAS protocols in gynaecological oncology, in experienced hands, it would be a beneficial tool related to decreased need of opioid use and nausea rates with no impact to hospital stay and PO complications, aiming to improve the perioperative quality of patient’s care.

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