INTRODUCTION
Regional anesthesia associated with general anesthesia can lead to the
reduction of harmful mediators (catecholamines, endogenous
corticosteroids) to the normal physiology of the body [1,2]. Reduced
stress hormones are referred to in most studies ever done. Despite this
beneficial effect, regional anesthesia can add blood flow reduction to
various tissues, as it can lead to sympathectomy due to spinal cord
levels blocked by local anesthetics very commonly used. This effect can
be accentuated by drugs administered in general anesthesia (inhalation
agents and inducers) [3].
In this context, a previous study analyzed the side effects of
postoperative epidural analgesia controlled with bupivacaine/sufentanil
versus an epidural bolus (BOLUS) of clonidine/morphine in 68 patients
with pancreatic surgery. Postoperative pain treatment was carried out
for 4 days, with 0.25% bupivacaine and 2 micrograms/mL sufentanil,
adjusted to a 3 mL bolus and 10 min blockade time. BOLUS patients
received injections of 150 microgram clonidine plus 2 mg morphine on
demand. It was concluded that, because of superior analgesia and reduced
side effects with similar costs, controlled postoperative epidural
analgesia is preferable to the BOLUS technique for the treatment of
postoperative pain. The epidural clonidine/morphine bolus technique
resulted in inferior analgesia, more side effects, and comparable costs
compared to a controlled epidural analgesia regimen after abdominal
surgery [4].
In this sense, in confirmation of the scientific evidence from the
previous study, a recent systematic review study carried out in 2021
explored the efficacy of different pain relief modalities used in the
treatment of postoperative pain after pancreaticoduodenectomy (PD) and
distal pancreatectomy (DP) and impact on perioperative outcomes. Five
randomized controlled trials and seven retrospective cohort studies
(1,313 patients) were included in the systematic review. Studies
compared epidural analgesia (EDA) (n=845), patient-controlled analgesia
(PCA) (n=425) and transabdominal wound catheters (TAWC) (n=43). EDA
versus PCA after PD was compared in eight studies (1,004 patients) in
the quantitative meta-analysis. Pain scores on days 2 (p = 0.19) and 4
(p = 0.18) and respiratory morbidity (p = 0.42) were comparable between
UDE and PDA. Operative times, bile leakage, delayed gastric emptying,
pancreatic fistula, opioid use, and length of stay were also comparable
between EDA and PDA. Pain scores and perioperative outcomes were
comparable between EDA and PCA after PD and EDA and TAWC after PD
[5].
In this sense, regional anesthesia associated with general anesthesia can lead to a reduction of harmful mediators (catecholamines, endogenous corticosteroids) to the normal physiology of the body. Reduced stress hormones are referred to in most studies ever done. Despite this beneficial effect, regional anesthesia can add blood flow reduction to various tissues, as this can lead to sympathectomy in spinal levels blocked by very commonly used Local anesthetics. This effect can be accentuated by drugs administered in general anesthesia (inhalation agents and inductors). Because of this finding, I recommended in this study the use of medications that do not produce neuraxial sympathectomy, which can lead to an excellent analgesic status both intraoperatively (CLONIDINE+SUFENTANIL) and postoperatively (CLONIDINE plus MORPHINE).
Because of this finding, the use of medications that do not produce
neuraxial sympathectomy will be evaluated in this study, which may lead
to an excellent analgesic status both intraoperatively (clonidine and
sufentanil) and postoperatively (clonidine and morphine). Therefore, this study aimed to assess hemodynamic variation, safety, immediate postoperative pain during the recommended anesthetic technique, aiming for an anesthetic plan around 50 in the BIS and perfusion parameters: Lactate below 2, mixed venous saturation above 80%, arterial and venous CO2 difference less than six, and hemoglobin above 10g/dL.