Effect of Epidural Analgesia on Goal-Directed Fluid Therapy with Pleth Variability Index in Patients Who Underwent Laparoscopic Colorectal Surgery

Objective: One of the most critical parameters of the ERAS protocol is perioperative fluid management. Goal-directed fluid therapy has advantages in this respect. We aimed to observe whether the epidural analgesia has an effect on intraoperative fluid replacement and postoperative recovery in patients who underwent major abdominal surgery in this study. Methods: Forty-six patients who underwent elective laparoscopic colon surgery under general anesthesia, aged 18-75, ASA I-III, were included in the study. The patients were divided into two groups as those who received epidural analgesia and those who did not receive epidural analgesia (intravenous, IV analgesia group). Goal-directed fluid therapy was arranged with Pleth Variability Index (PVI) monitoring in both groups. Results: There was no difference in the amount of the fluid administered and the hemodynamic parameters between the groups. Intraoperative PVI trend significantly decreased in the epidural group while it was stable in the IV analgesia group. (p=0.03). Body temperature was significantly lower at the end of the surgery compared to the beginning of the epidural analgesia group (p<0.001). But no significant change n body temperature was observed in the IV analgesi group (p=0.182). There was no difference between groups in terms of hospital length of stay, postoperative complications, and clinical recovery time. Conclusion: The administration of epidural analgesia does not have an advantage in comparison to the IV analgesia group in terms of targeted fluid therapy and the postoperative process and recovery time in laparoscopic colorectal surgery performed under general anesthesia. More detailed evaluations are needed for the effectiveness of PVI in intraoperative fluid therapy optimization.