{
  "abstract": "Background and Aims Mid-thoracic epidural analgesia is a standard practice for postoperative pain relief following transthoracic esophagectomy. However, in minimally invasive surgeries, non-epidural systemic analgesics are more frequently utilised for pain management. This study aimed to compare the efficacy and safety of two modalities in minimally invasive esophagectomy (MIE) procedures.Methods Following PROSPECT recommendations, the institutional policy shifted from epidural to systemic analgesics in MIE surgeries. 1 After obtaining Ethics Committee approval, we compared a historical cohort of patients receiving epidural analgesia (n=96) with those who received systemic analgesia (n=97) during the period from 2019 to 2023. Information on the historical cohort was retrieved from the institutional electronic medical records, while prospectively recruited patients were followed for up to four postoperative days by the designated team. For both groups, we noted information on postoperative pain [i.e. Numerical Rating Scale (NRS) score from day 0 to day 4, worst pain scores, and analgesic modalities, along with the incidence of their side effects on each day].Results The NRS scores (at-rest and dynamic) were significantly lower in the epidural group compared to the non-epidural group for the first two postoperative days [Day1- Median (IQR) NRS-5 (5,6) versus 6 (5,6), p <0.001, Day 2- 4 (4,5) versus 5 (4,5) p < 0.001)][ figure 1]. Requirement of patient-controlled analgesia (as a rescue analgesic) was significantly more in non-epidural group.[day 1- 1% versus 14.4%, p = 0.001] [figure 2] Intensity of the pain scores and the requirement for opioid analgesics decreased from the third postoperative day and were comparable in both groups. Postoperative outcomes (mortality and hospital stay) were similar in both groups (p=0.465).Abstract EP007 Figure 1Comparison of NRS scoresAbstract EP007 Figure 2Requirement of PCAsConclusions NRS scores following MIE surgeries ranged from mild to moderate. Epidural analgesia significantly reduced the pain; however, the clinical difference is minimal compared to systemic analgesics. Multimodal systemic analgesics provide adequate pain relief after MIE surgeries.",
  "authors": [
    {
      "affiliations": [
        "Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Mumbai, India"
      ],
      "name": "Swapnil Parab"
    },
    {
      "affiliations": [
        "Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Mumbai, India"
      ],
      "name": "Snehal Mahatme"
    },
    {
      "affiliations": [
        "Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Mumbai, India"
      ],
      "name": "Sumitra Bakshi"
    },
    {
      "affiliations": [
        "Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Mumbai, India"
      ],
      "name": "Priya Ranganathan"
    },
    {
      "affiliations": [
        "Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Mumbai, India"
      ],
      "name": "Madhavi Shetmahajan"
    }
  ],
  "title": "EP007 A comparative study of epidural analgesia versus systemic analgesia for the pain management following minimally invasive esophagectomy (MIE) surgeries at a tertiary care cancer centre",
  "uid": "f9c09411-04b2-5f0b-9fd3-08332ecb8809"
}