A hundred patients scheduled for
cholecystectomy were randomized to either thoracic epidural anaesthesia and
analgesia for 24 h with
bupivacaine intraoperatively about 100 mg and 15 mg/h thereafter (
TEA) for postoperative
analgesia,
TEA combined with general anaesthesia (low dose
fentanyl) (
TEA + GA) and general anaesthesia (GA) (low dose
fentanyl). During
TEA and
TEA + GA the arterial pressure was significantly decreased as compared with GA.
TEA was associated by an intense haemodilution in comparison with GA.
Blood glucose and plasma
cortisol responses were significantly suppressed by
TEA. The decreases in peripheral blood lymphocyte and eosinophilic counts observed after operation under GA was significantly reduced by
TEA. The increase in the neutrophil count was inhibited by
TEA but the increase in non-filamented neutrophils was significantly augmented by
TEA. The postoperative alleviation of the alteration of the above mentioned parameters by
TEA was slightly diminished in the
TEA + GA group. However, we found no significant reduction in cardiac dysrhythmias (
TEA 7%,
TEA + GA 7% and GA 10%), ST-segment depression (
TEA 17%),
TEA + GA 3.3% and GA 12.5%),
wound complication (
TEA 3%,
TEA + GA 0%, GA 0%),
pneumonia (
TEA 3%,
TEA + GA 3% and GA 0%),
subphrenic abscess (
TEA 6%,
TEA + GA 0%, GA 3%), mortality (
TEA 0%,
TEA + GA 3%, GA 0%), and urinary tract infect (
TEA 17%,
TEA + GA 7% and GA 2.5%). Since an equal number of patients in each group, about 30%, suffered one or more of the postoperative complications this
epidural analgesia was not effective in reducing postoperative morbidity albeit the significant alleviation of the postoperative stress response.