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Minerva Anestesiologica 2004 January-February;70(1-2):83-9

Copyright © 2003 EDIZIONI MINERVA MEDICA

language: English, Italian

Cytopathologic examination of epidural catheter for postoperative analgesia. Pathophysiology and clinical management

Carrossino D. ¹, Zappi L. ¹, Gipponi M. ², Bassetti C. ³, Maurelli A. ¹, Mignone L. ¹, Villani L. ¹, Spina B. ⁴, Tami M. ⁵, Cecchini A. ⁵, Calandri P. G. ¹

¹ Anesthesia and Resuscitation Unit National Cancer Research Institute (IST) Genoa, Italy 2 Surgical Oncology Unit National Cancer Research Institute (IST) Genoa, Italy 3 Obstetric Anesthesia Unit Anesthesia and Resuscitation Service San Martino Hospital, Genoa, Italy 4 Anatomy and Cytopathology Unit National Cancer Research Institute (IST) Genoa, Italy 5 Anesthesia and Resuscitation Unit Villa Scassi, Genoa, Italy

Aim. The ­authors per­formed a pros­pec­tive ­study in a ­series of ­patients under­go­ing com­bined gen­er­al and epi­du­ral anaesthe­sia for ­major abdom­i­nal sur­gery in ­order to ­define if the epi­du­ral cath­e­ter insert­ed for post­op­er­a­tive anal­ge­sia ­induced in the ­short-­term (7-8 post­op­er­a­tive ­days) any cyto­path­o­log­i­cal­ly appre­ciable inflam­ma­to­ry ­response.
Methods. From April to September 2001, 20 con­sec­u­tive ­patients under­go­ing com­bined gen­er­al and epi­du­ral anaesthe­sia for ­major abdom­i­nal sur­gery at the National Cancer Research Institute and Villa Scassi Hospital (Genoa), ­were recruit­ed ­after obtain­ing Institutional Ethics Committee approv­al and writ­ten con­sent ­from the ­patients. The stan­dard tech­nique for epi­du­ral anaesthe­sia was adopt­ed. Preoperatively, all ­patients ­received per­i­du­ral­ly a ­dose ­test of 3 ml of 2% lid­o­caine (60 mg) fol­lowed by 5 ml of ropiv­a­caine 0.75%, and a con­tin­u­ous infu­sion of ropiv­a­caine 0.375% (5-10 ml/h; max­i­mal ­dose=20 ml) intra­op­er­a­tive­ly. As ­regards the ther­a­peu­tic man­age­ment of post­op­er­a­tive anal­ge­sia, ­patients ­received a con­tin­u­ous infu­sion of ropiv­a­caine 0.2% for at ­least 48 hours and sup­ple­men­tal ­bolus (2 mg/die) of mor­phine hydro­chlo­ride. The epi­du­ral cath­e­ter was ­always ­removed ­between the 7th and 8th post­op­er­a­tive day, and it was exam­ined by the pathol­o­gist accord­ing to the Thin Prep 2000 pro­ce­dure.
Results. The cyto­path­o­log­ic exam­ina­tion of the tip of the epi­du­ral cath­e­ter ­gave the fol­low­ing find­ings: amor­phous mate­ri­al with­out ­cells (n=10); ­rare gran­u­loc­y­tes and his­tio­cy­tes (n=6); stro­mal ­cells (n=3), and ­rare lym­pho­cytes (n=1).
Conclusion. We ­were ­unable to ­detect any cyto­path­o­log­i­cal­ly appre­ciable inflam­ma­to­ry ­res-ponse at the tip of the epi­du­ral cath­e­ter ­which ­could ­have sug­gest­ed the occur­rence of inflam­ma­tion in the epi­du­ral tis­sues. Given the pos­i­tive ­results of pro­phy­lac­tic epi­du­ral admin­is­tra­tion of ­small dos­es of cor­ti­cos­ter­oids in the reduc­tion of ­postepi­du­ral anaesthe­sia ­back ­pain and ­their ­direct mem­brane ­action on noc­i­cep­tive C-­fibers, ­this ­kind of back­ache ­seems to be relat­ed to the stim­u­la­tions of ­such noc­i­cep­tors ­more ­than to a cath­e­ter-relat­ed inflam­ma­to­ry ­response of epi­du­ral tis­sues ­with pos­sible evo­lu­tion in per­i­du­ral fibro­sis, as report­ed fol­low­ing sur­gi­cal inter­ven­tion for lum­bos­a­cral dis­ease.