Thoracic but not lumbar epidural anaesthesia increases liver blood flow after major abdominal surgery.

Background and objective Epidural blockade in major abdominal surgery beers the potential to increase gastrointestinal perfusion and thus to improve patient outcome. The aim of this study was to assess the differential influence of thoracic and lumbar epidural anaesthesia and analgesia (EAA) on blood lactate levels and central venous oxygen saturation (ScvO(2)) as parameters of global oxygen supply/demand ratio, as well as on the plasma disappearance rate of indocyanine green (PDRICG), a noninvasive method to evaluate liver perfusion. Methods We enrolled 17 patients receiving thoracic and 17 patients receiving lumbar EAA in addition to general anaesthesia for major abdominal surgery. Lactate, ScvO(2) and PDRICG were measured postoperatively on the ICU. Subsequently, epidural application of local anaesthetics was started with a bolus of bupivacaine 0.25% (thoracic 10 ml, lumbar 12 ml) followed by continuous infusion of bupivacaine (thoracic 8 ml h(-1) 0.175%, lumbar 10 ml h(-1) 0.125%) and fentanyl (2 mu g ml(-1)). Central venous pressure was maintained by titrated volume replacement. Lactate, ScvO(2) and PDRICG were measured again after 2 h. Results In both the groups, the mean arterial pressure and heart rate as well as lactate levels and ScvO(2) did not change significantly. Although there was a slight but not significant decrease of PDRICG in patients with lumbar EAA (from 25.9 +/- 7.68 to 23.2 +/- 5.90; NS), thoracic EAA resulted in a significant increase of PDRICG (from 21.3 +/- 5.13 to 24.0 +/- 6.66; P<0.05) for the group mean, but with substantial variability in individual patients in the lumbar EAA group. Conclusion Liver perfusion was increased with thoracic but not lumbar EAA after major abdominal surgery in most patients. PDRICG allows assessment of individual changes of liver blood flow due to therapeutic intervention, for example, EAA. Eur J Anaesthesiol 26:111 - 116 (c) 2009 European Society of Anaesthesiology.