Effects of Erector Spina Plan Block and Epidural Analgesia in Whipple Surgery
Condition: Pancreatic Cancer
Study type: Observational

Summary: 
      Pancreatic surgery is generally a high-risk and difficult to manage perioperatively.

      surgery. In pancreatic surgery, in addition to general anaesthesia, central blocks for
      analgesia and peripheral blocks are also preferred. In this study, in patients undergoing
      whipple surgery epidural and erector spina plan block (ESP) may cause intraoperative and
      postoperative pain, renal functions and haemodynamic variables.
    

Detailed description: 
      Pancreatic surgery and anaesthetic management is a difficult operation due to the anatomical
      location and function of the pancreas. Thoracic epidural anaesthesia/analgesia (TEA) in
      addition to general anaesthesia in upper abdominal surgeries such as pancreas, liver and
      stomach.Thoracic epidural analgesia (TEA) is the most widely used gold standard in this type
      of surgery.

      TEA may cause haemodynamic changes in patients due to decreased sympathetic tone due to
      sympathetic nerve blockade. In elderly patients, bradycardia and hypotension is observed more
      frequently. Cardiovascular response decreases with age due to decreased cardiac reserve and
      deterioration of the autonomic nervous system and arteriolar structure. This can lead to this
      is because more segments are blocked than in younger patients. Pain control with thoracic
      epidural will provide pulmonary rehabilitation and rapid mobilisation. Accordingly,
      thromboembolic events, atelectasis and pulmonary infections are prevented. However, it has
      important unwanted side effects such as hypotension, dural puncture and contralateral block.
      All these disadvantages of TEA has increased interest in alternatives. Peripheral regional
      anaesthesia techniques have become more popular as a component of multimodal analgesia to
      avoid complications associated with epidural analgesia.

      In 2016, ESP block, which is an ultrasound-controlled fascial plane block, was described. ESP
      block is considered to be an easier, effective and safer alternative to epidural and
      paravertebral blocks. The mechanism of action of ESP involves blockade of both dorsal and
      ventral branches, resulting in somatic and visceral analgesia.

      Intraoperative and postoperative renal function may be impaired in upper abdominal surgeries.
      Acute kidney injury (AKI) is an important cause of postoperative mortality and morbidity. The
      most serious adverse factor is both surgical and anaesthesia-related AKI.

      hypotension that may develop. The duties of the anaesthesiologist include maintaining
      perioperative renal function, predetermining the risk of AKI and taking necessary
      precautions. Considering the data in the literature, postoperative AKI Recent studies have
      shown that there is a link between inflammation and cancer. Studies reveal a relationship
      between cytokine and chemokine production and tumour growth, angiogenesis and metastatic
      capacity. Inflammatory cells and substances produced by inflammation affect cells in the
      peripheral blood. Platelets promote extravasation of circulating tumour cells. Neutrophils
      can also promote tumour adhesion and seeding by secreting growth factors into the peripheral
      circulation. However, lymphocytes can exert anti-tumour effects by inhibiting the
      proliferation and migration of tumour cells. From this point of view, SII (Systemic
      inflammation index) is a new prognostic factor obtained by measuring the number and ratio of
      neutrophils, platelets and lymphocytes in the peripheral blood of many tumours.

      In this study, the effects of epidural analgesia and ESP block on intraoperative opioid
      requirement and postoperative pain scores, as well as perioperative renal parameters,
      haemodynamic data and SII (Systemic inflammation index) were investigated and the alternative
      of ESP block to epidural analgesia was investigated.
    

Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patients who will have whipple surgery operation under general anesthesia in Ankara Bilkent
        City Hospital Operating Room,between the ages of 18-80,both genders and in the ASA (The
        American Society of Anesthesiologists) 1,2,3 risk grup will be included in the study.