• S Møiniche, J B Dahl, J Rosenberg, and H Kehlet.
• Department of Anesthesiology, Hvidovre University Hospital, Copenhagen, Denmark.
• Reg Anesth. 1994 Sep 1;19(5):352-6.

Background And ObjectivesA pulmonary high-risk patient undergoing right hemicolectomy for cancer was treated with a combination of intense afferent neural block with subarachnoid-epidural local anesthetics followed by continuous epidural analgesia, preoperative high-dose glucocorticoids, and early oral feeding and mobilization.MethodsIntraoperative subarachnoid anesthesia was followed by epidural analgesia with bupivacaine and morphine for 72 hours and oral acetaminophen 1 g every 6 hours.ResultsThe technique resulted in a pain-free postoperative course (rest and mobilization) with unchanged pulmonary function. Nocturnal episodic oxygen desaturation, hyperthermia, and postoperative fatigue were prevented. Defecation occurred on the first postoperative day and oral caloric intake was normal after 24 hours with no postoperative weight loss. Self care was normalized on the third postoperative day and the patient discharged from the hospital 80 hours after surgery.ConclusionsThe technique of combined neural and humoral mediator block should be evaluated in other high-risk patients undergoing major surgical procedures, where minimal invasive techniques are not possible.

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