Combined general and epidural anesthesia versus general anesthesia for major abdominal surgery: Postanesthesia recovery characteristics

Background and Objectives. Outcome studies comparing general anesthesia combined with epidural anesthesia (GEN-EPI) to general anesthesia (GEN) for major abdominal surgery have been equivocal. However, many believe that patients anesthetized with GEN-EPI fair better than GEN. This study tests the hypothesis that there are favorable recovery characteristics associated with GEN-EPI as compared with GEN following abdominal surgery. Methods. A prospective randomized double-blind trial, consisting of 30 patients ages 18-74 undergoing abdominal surgery was undertaken. Patients received either GEN-EPI or GEN by standardized protocol. At the end of surgery the epidural catheter was removed and psychological testing was performed over 24 hours to determine recovery characteristics. These included the modified Slater test, the Self-Assessment Manikin, the Kendrick Digital Copying Test, the Hospital Anxiety and Depression Scale, as well as visual analog scales for pain and appearance. Results. Patients receiving GEN-EPI emerged from anesthesia faster (P < .03) with less pain on awakening (P < .04 at rest; P < .01 on coughing), had better psychomotor function at 2 hours (P < .04), and were less drowsy at 4 hours (P < .04), than patients with GEN. There was no difference in pain intensity after the initial assessment, morphine usage, mood, anxiety, and depression at any other measurement period. Conclusion. Transient quantifiable differences in recovery characteristics exist between patients receiving GEN-EPI and GEN.