Influence of pre-peritoneal vs. epidural levobupivacaine infusion on troponin I and BNP as predictors of cardiac injury in cancer patients undergoing major upper abdominal operations: A randomized controlled clinical trial

Figures & data

Figure 1. CONSORT flow chart of the participants.

Table 1. Demographic characteristics of two study groups.

	Groups			p-value
		ECI (n = 30)	PCI (n = 30)
Sex (n) male female		12 (40.0%)	14(46.7%)	0.614
		18 (60.0%)	16 (53.3%)
Age (y) median (range)		61.72 (20.03–70.12)	59.33 (22.08–70.25)	0.489
BMI (kg/m2) median (range)		22.84 (17.78–35.44)	24.73 (18.54–35.28)	0.453
Time of Anesthesia (hours)		3.30 (2.30–5.00)	3.73 (2.30–5.00)	0.067
Time of Surgery (hours)		3.00 (2.00–4.45)	3.08 (2.00–4.45)	0.057
Type of operation (n) −cancer stomach Cancer esophagus − Cancer colon − Cancer liver − Mesenteric mass −Renal malignancies − Cancer pancreas − cancer Gall bladder		10 (33.3%) 7 (23.3%) 3 (10.0%) 4 (13.3%) 1 (3.3%) 2 (6.7%) 2 (6.7%) 1 (3.3%)	6 (20.0%) 7 (23.3%) 5 (16.7%) 3 (10.0%) 1 (3.3%) 3 (10.0%) 2 (6.7%) 3 (10.0%)	0.899
ASA class (n) I/II/III		9/16/5 (30.0%/53.3% /16.7%)	13/14/3 (43.3%/46.7%/10.0%)	0.514

Table 2. CVP over study time, Intra-op. fentanyl consumption, first need of analgesia, and 48 h total morphine consumption between the two groups.

	Group		p-value
	ECI (n = 30)	PCI (n = 30)
	Median (Range)	Median (Range)
CVP pre-operative (Cm.H2o)	8.00 (3.00–13.00)	8.00 (3.00–13.00)	0.883
CVP24 h(Cm.H2o)	9.00 (5.00–16.00)	10.00 (5.00–16.00)	0.423
CVP 48 h (Cm.H2o)	11.50 (9.00–16.00)	12.00 (9.00–16.00)	0.438
p-value over time	<0.001*	<0.001*
Intra-op. fentanyl consumption (μg) median (IQR)	200.00 (100.00–250.00)	200.00 (150.00–250.00)	0.497
First need of Analgesia (h) mean±SD	8.40 ± 12.08	4.83 ± 7.76	0.252
48 h Total morphine consumption (mg) median (IQR)	7.00 (6.00–8.00)	9.00 (7.00–10.00))	0.002*

Figure 2. Postoperative NRS score over study time between two study groups.

Table 3. Perioperative mean blood pressure over study time between the two study groups.

	Groups
	ECI (n = 30)	PCI (n = 30)	P-value
	Mean ±SD	Mean ±SD
mean BP baseline (pre-op)	100.40 ± 11.15	100.77 ± 12.69	0.906
mean Bp 1 h (Intra-op)	82.97 ± 9.86	80.70 ± 10.84	0.400
mean Bp 2 h (Intra-op)	82.27 ± 7.06	80.30 ± 7.21	0.290
mean Bp 3 h (Intra-op)	84.87 ± 5.52	84.63 ± 5.90	0.875
mean Bp 4 h (Intra-op)	90.10 ± 4.86	89.43 ± 5.20	0.610
mean Bp 5 h (Intra-op)	95.63 ± 4.41	94.90 ± 5.03	0.551
mean BP 0 h (Immediately post-op)	77.30 ± 12.83	81.13 ± 14.85	0.219
mean BP2h	74.63 ± 13.40	82.43 ± 15.28	0.052
mean BP4h	75.20 ± 14.08	83.47 ± 16.55	0.054
mean BP6h	79.20 ± 13.37	85.43 ± 13.20	0.091
mean BP12h	83.80 ± 12.64	87.67 ± 9.70	0.099
mean BP24h	86.43 ± 11.32	88.87 ± 7.25	0.134
mean BP36h	88.27 ± 8.07	91.13 ± 7.65	0.163
mean BP48h	93.43 ± 8.20	94.03 ± 7.71	0.771

Table 4. Perioperative heart rate over study time between the two study groups.

	Groups		p-value
	ECI (n = 30)	PCI (n = 30)
	Mean ±SD	Mean ±SD
HR baseline (Pre. Op)	90.80 ± 14.04	89.03 ± 13.10	0.616
HR 1 h (Intra. Op.)	74.20 ± 8.88	78.27 ± 11.99	0.141
HR 2 h (Intra. Op.)	77.57 ± 7.25	77.07 ± 9.89	0.824
HR 3 h (Intra. Op.)	77.70 ± 7.11	77.00 ± 8.40	0.729
HR 4 h (Intra. Op.)	79.60 ± 5.98	78.77 ± 7.31	0.631
HR 5 h (Intra. Op.)	85.53 ± 7.45	86.10 ± 8.57	0.786
HR 0 h (immediately post. Op.)	104.10 ± 11.23	105.33 ± 9.82	0.652
H.R 2 H	93.87 ± 13.42	96.60 ± 10.81	0.389
H.R 4 H	88.50 ± 9.79	91.67 ± 6.41	0.381
H.R 6 H	86.20 ± 8.38	89.53 ± 6.33	0.125
H.R 12 H	84.50 ± 7.72	85.33 ± 6.08	0.419
H.R 24 H	79.33 ± 5.78	81.50 ± 6.05	<0.030*
H.R 36 H	85.37 ± 3.86	92.70 ± 6.68	<0.001*
H.R 48 H	91.23 ± 6.54	95.77 ± 6.98	0.001*

Figure 3. Box and whisker plot showing troponin distribution over study time and between two studied groups.

Figure 4. Box and whisker plot showing BNP distribution over study time and between two studied group.

Table 5. Postoperative side effects and cardiovascular complications between the two study groups.

	Group		p-value
	ECI (n = 30) n (%)	PCI (n = 30) n (%)
Vomiting	7/30 (23.3%)	4/30 (13.3.0%)	0.317
Nausea	8/30 (26.7%)	6/30 (20.0%)	0.542
Hypotension	8/30 (26.7%)	2/30 (6.7%)	0.038*
Bradycardia	7/30 (23.3%)	1/30 (3.3%)	0.023*
Hypertension	1/30 (3.3%)	2/30 (6.7%)	0.554
Dysrhythmia (Newly diagnosed)	2/30 (6.7%)	1/30 (3.3%)	0.554
Angina	0/30	0/30	-
Myocardial injury (MI)	0/30	0/30	-
Heart failure	0/30	0/30	-