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.