The comparison of the effects of epidural anesthesia applied with different doses with TIVA in major gynecologic surgery

In this study, our aim was to investigate the superiority and differences of intraoperative hemodynamics, intraoperative anesthetic agent requirement, the cost of anesthetic agents and the quality of postoperative analgesia in patients who were performed major gynecological surgery under the TIVA compared to TIVA+EA, carried out using different concentrations of levobupivacaine. A total of 100 patients who were scheduled for major gynecological surgery, between the ages of 18 and 65, ASA I-II were included in the study. Patients were randomly divided into 4 groups as Group 1, Group 2 and Group 3 which applied lumbar EA with TIVA and and group 4 which received only TIVA including 25 people in each group. Patients were enrolled in the sitting position. The EA was performed by entering at the L3-L4 interspace. Twenty ml of levobupivacaine inthe concentrations of 0.0625% (Group 1), 0.125% (Group 2), 0.25% (Group 3) were given to patients with EA. Two mg/kg propofol and 0.5 mg / kg rocuronium bromide were iv administered to all patients for induction of anesthesia and intubation was performed. In all 4 groups, TIVA was performed with the infusion ofpropofol 6-12 mg/kg/h and remifentanil 0.01-0.1 mcg/kg/min. BIS monitoring were performed in patients of all groups. At the end of surgery, neuromuscular block was antagonized and the patients were extubated. In our study, we observed that the recovery period was shorter, the consumption of propofol-remifentanil, the cost of propofol-remifentanil were lower, the duration of first emergence analgesic requirement in first 24-hours was longer and the duration of first mobilization was shorter and the satisfaction of surgery was better in patients applied TIVA+different doses of levobupivacaine with EA than in patients applied only TIVA and in group 2 (0.125%) than in the other groups applied EA. We think that the anesthesia performed using TIVA+EA is more advantageous than TIVA alone in patients undergoing major gynecological surgerybased on intraoperative hemodynamics, intraoperative anesthetic agent requirements, costs and the postoperative analgesia quality, also, the levobupivacaine in the concentration of 0.125% given epidurally is the optimaldose to provide such effects.