Anestesia e Pesquisa Clínica
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Thoracic Epidural Anaesthesia in Awake Upper Abdominal Surgery: Safety/Validity of Bromage’s Formula

Giovanni Consani, Anna Nunziata, Gabriella Amorese and Ugo Boggi

Objective: Subtotal gastrectomy has been successfully performed using thoracic epidural anaesthesia alone in two high-risk surgical patients. We describe these two cases by using the Bromage’s formula to calculate the required doses for a satisfactory segmental block. Case Report: Two high-risk surgical patients were scheduled for sub-total gastrectomy. They received thoracic epidural anaesthesia alone. An 18-gauge Tuohy needle was introduced at T8/T9 intervertebral space and the tip of the catheter was advanced 3 cm cephalad beyond the tip of the needle (T7/T6). Epidural anaesthesia was established with 0.5% levobupivacaine and sufentanil. The used doses were calculated according to the formula: x mg=(n. of dermatomes+6) ∙ mg/segment. Conclusions: Thoracic epidural anaesthesia provides optimal perioperative anaesthesia and analgesia after thoracic and major abdominal surgery and decreases postoperative morbidity and mortality, mainly by blocking sympathetic nerve fibers. An experienced operator can use it as the sole anesthetic technique in selected cooperative patients. The Bromage’s formula can be a useful clinical aid for the anaesthetist in the described settings.