Abstract
PURPOSE: Postoperative sleep disturbance is one of the most important factors affecting rapid postoperative recovery. The aim of the present study was to investigate the effects of combined epidural and general anesthesia on postoperative sleep and pain in elderly patients undergoing gastrointestinal tumor surgery. PATIENTS AND METHODS: Ninety patients who were scheduled to undergo elective gastrointestinal tumor surgery were randomly divided into the general anesthesia (GA) and epidural combined with GA (GEA) groups. A wireless smart bracelet was used to measure objective sleep quality on the night before surgery (Preop 1), and on the first, third, and seventh night after surgery (POD1, POD3, and POD7, respectively). Subjective sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) scale. Furthermore, the total dose of general anesthetics required and postoperative pain and adverse effects were assessed. RESULTS: PSQI was higher on postoperative day 1 and day 3 than on preoperative day 1 in both groups. In addition, on postoperative day 1 and postoperative day 3, PSQI scores were lower in the GEA group than in the GA group. On postoperative day 1, the sleep scores, rapid eye movement sleep, and percentage of stable sleep were higher in the GEA group than in the GA group. remifentanil dosage and the incidence of postoperative nausea and vomiting were significantly lower in the GEA group than in the GA group. There was no significant difference in VAS scores at 6, 24, 48 h after operation and total PCA demand attempts within 48 h after operation between the two groups. CONCLUSION: Elderly patients usually experience considerable sleep disturbances after gastrointestinal tumor surgery. Epidural combined with GA can effectively improve postoperative short-term sleep quality and reduce the incidence of postoperative nausea and vomiting. This may be related to the reduction of intraoperative consumption of remifentanil under epidural anesthesia. However, the pain within 48 h after the operation was not improved in this study. TRIAL REGISTRATION: The study was registered at Chinese Clinical Trial Registry http//www.chictr.org.cn/ (Registration date 04/04/2021 Trial ID ChiCTR2100045064).