ĐÁNH GIÁ HIỆU QUẢ PHƯƠNG PHÁP KẾT HỢP GÂY TÊ NGOÀI MÀNG CỨNG BẰNG HỖN HỢP ROPIVACAIN - FENTANYL VỚI GÂY MÊ NỘI KHÍ QUẢN TRONG PHẪU THUẬT UNG THƯ ĐẠI TRỰC TRÀNG

Abstract

Objective: Evaluating the efficacy of combining epidural anesthesia (EA) with general anesthesia (GA) in reducing anesthetic and fentanyl requirements, emergence time, and assessing adverse effects in colorectal cancer surgery. Methods: A randomized controlled trial was conducted with two groups. Group 1 (n = 30): Patients received EA (ropivacaine 0.5% + fentanyl 5 µg/ml) combined with GA, with postoperative analgesia managed via EA. Group 2 (n = 30): Patients received GA (induction with propofol, maintenance with sevoflurane, intraoperative analgesia with fentanyl), with postoperative pain control through PCA morphine. Results: Fentanyl consumption during anesthesia was significantly lower in Group 1 (153.3 ± 41.4 µg) than in Group 2 (391.7 ± 96.6 µg). Sevoflurane maintenance concentrations ranged from 1–1.8% in Group 1 compared to 1.8–3% in Group 2. Average extubation times were 15.4 ± 6.4 minutes for Group 1 and 24.5 ± 7.6 minutes for Group 2 (p < 0.001). A higher proportion of patients in Group 2 reported VAS pain scores ≥ 4 during postoperative mobilization. Severe hypotension occurred in 10% of Group 1 and 3.3% of Group 2. Conclusion: Combining EA with GA effectively reduces intraoperative anesthetic and opioid requirements, shortens recovery times, and provides substantial postoperative analgesia, although it may increase the risk of hypotension during induction.