{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T07:22:25Z","timestamp":1773213745240,"version":"3.50.1"},"reference-count":24,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,11,21]],"date-time":"2017-11-21T00:00:00Z","timestamp":1511222400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2017,11,21]],"date-time":"2017-11-21T00:00:00Z","timestamp":1511222400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Excellent analgesia following oesophagectomy facilitates patient comfort, early extubation, physiotherapy and mobilisation, reduces post\u2010operative complications and should enhance recovery. Thoracic epidural analgesia (TEA), the gold standard analgesic regimen for this procedure, is often associated with systemic hypotension treated with inotropes or fluid. This may compromise enhanced recovery and be complicated by anastomotic ischaemia or tissue oedema.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We report a novel analgesic regimen to reduce post\u2010operative inotrope usage. Infusion of ropivicaine via bilateral preperitoneal and right paravertebral catheters was used. Patient\u2010controlled epidural pethidine provided rescue analgesia (WC) (<jats:italic>n<\/jats:italic> = 21). A retrospective audit of inotrope requirement, mean pain scores, episodes of respiratory depression and excessive sedation, need for reintubation, reoperation in the first 5 post\u2010operative days, time to mobilisation, time in intensive care, time in hospital and 30\u2010day mortality were measured. These results were compared with those of an earlier patient group who received a thoracic epidural infusion of low\u2010dose local anaesthetic and fentanyl (TEA) (<jats:italic>n<\/jats:italic> = 21).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Inotrope use was reduced by 29% in the WC group (<jats:italic>p<\/jats:italic> = 0.03) and the mean intensive care stay reduced by 2.4\u00a0days (<jats:italic>p<\/jats:italic> = 0.03), as was reintubation rate (<jats:italic>p<\/jats:italic> = 0.01) and early mobilisation (<jats:italic>p<\/jats:italic> = 0.03). The pain score was comparable in both groups, and there was no difference in the other outcomes examined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The data demonstrated that it was possible to provide excellent post\u2010oesophagectomy analgesia equivalent to thoracic epidural infusions of local anaesthetic with reduction in inotrope requirements, intensive care stay, more rapid mobilisation, facilitating enhanced recovery.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-017-4369-9","type":"journal-article","created":{"date-parts":[[2017,11,21]],"date-time":"2017-11-21T18:28:29Z","timestamp":1511288909000},"page":"1787-1791","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["A Novel Technique of Paravertebral Thoracic and Preperitoneal Analgesia Enhances Early Recovery After Oesophagectomy"],"prefix":"10.1002","volume":"42","author":[{"given":"Stephanie","family":"Phillips","sequence":"first","affiliation":[{"name":"Sydney Adventist Hospital Wahroonga, Sydney Australia"},{"name":"University of Sydney Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jasmina","family":"Dedic\u2010Hagan","sequence":"additional","affiliation":[{"name":"Sydney Adventist Hospital Wahroonga, Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"d\u2019Arcy Ferris","family":"Baxter","sequence":"additional","affiliation":[{"name":"Sydney Medical School University of Sydney Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H.","family":"Van der Wall","sequence":"additional","affiliation":[{"name":"Concord Nuclear Imaging Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9052-2061","authenticated-orcid":false,"given":"G. 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