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CRITICAL CARE AND TRAUMA

The Effect of Thoracic Epidural Bupivacaine and an Intravenous Adrenaline Infusion on Gastric Tube Blood Flow During Esophagectomy

Omar Y. Al-Rawi, FRCA^*, Stephen H. Pennefather, MRCP, FRCA^*, Richard D. Page, FRCS, Ishani Dave, FRCA^*, and Glen N. Russell, FRCA^*

From the Departments of *Anaesthesia and Thoracic Surgery, Cardiothoracic Centre, Liverpool, United Kingdom.

Address correspondence to Stephen H. Pennefather, MRCP, FRCA, Department of Anaesthesia, Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE, UK. Address e-mail to stephen.pennefather{at}ctc.nhs.uk.

BACKGROUND: Gastric tube necrosis is a major cause of anastomotic leak after esophagectomy. A correlation has been shown between reduced flux at the anastomotic end of the gastric tube and anastomotic leaks.

METHODS: We prospectively studied the effect of intraoperative thoracic epidural bupivacaine and subsequent adrenaline infusion on hemodynamics and flux in the gastric tube.

RESULTS: Administering the epidural bolus significantly decreased flux at the anastomotic end of the gastric tube (P < 0.01). Gastric flux was returned to baseline by an adrenaline infusion.

CONCLUSIONS: The administration of a thoracic epidural bolus may decrease flux at the anastomotic end of the gastric tube.