Effect of general anesthesia combined with epidural block on hemorheology in elderly patients with laparoscopic radical resection of colorectal cancer: A randomized controlled trial

Abstract

Background

Laparoscopic surgery is widely used in the field of clinical surgery due to its minimal trauma, minimal bleeding, short hospital stay, and fast postoperative recovery. There were several studies found that elderly patients undergoing laparoscopic surgery are more prone to coagulation disorders, increased blood viscosity, and the influence of CO₂ pneumoperitoneum, which can easily lead to changes in blood rheology There are no studies have investigated the effects on blood rheology of general anesthesia combined with epidural block on hemorheology in elderly patients undergoing laparoscopic radical resection of rectal cancer. This trial investigated to explore the effect of general anesthesia combined with epidural block on blood rheology in elderly patients undergoing laparoscopic radical resection of rectal cancer, providing experimental basis for clinical anesthesia to regulate blood rheology characteristics and prevent hyperviscosity and its complications.

Methods

A total of 60 patients undergoing laparoscopic radical resection of colorectal cancer, aged 60–75 years, with American Society of Anesthesiologists physical status III, were enrolled in this study. All the subjects were randomly divided into general anesthesia group (group G, n = 30) and general anesthesia in combination with epidural block group (group G + E, n = 30) according to a random number table. Patients in the group G received the general anesthesia alone while those in the group G + E were given the combined epidural block based on anesthetic method of group G. The arterial blood gas indexes (pH, PaCO₂ and HCO₃⁻) and hemodynamic indexes(Hŋ_b, Lŋ_b,η_p, EAI, Hct and ESR) were measured at four time points: before induction of general anesthesia (T₀), 5 min before establishment of pneumoperitoneum (T₁), 30 min after establishment of pneumoperitoneum (T₂) and 30 min after elimination of pneumoperitoneum (T₃).

Results

There was no significant statistical difference (p > 0.05) in pH, PaCO₂, and HCO₃⁻ between the two groups at T₁, T₂, and T₃. At T₀, there was no significant difference (p > 0.05) in Hŋ_b, Lŋ_b, η_p, Erythrocyte Aggregation Index (EAI), Hct, and Erythrocyte Sedimentation Rate (ESR) between the two groups. However, these indices were significantly lower in group G + E than in group G (p < 0.05) at T₁, T₂, and T₃.

Conclusion

Combining general anesthesia with epidural block can effectively reduce the hemorheological indexes of patients and improve the hemorheological state in elderly patients with malignant tumors undergoing laparoscopic surgery.