A Prospective Randomized Study of the Potential Benefits of Thoracic Epidural Anesthesia and Analgesia in Patients Undergoing Coronary Artery Bypass Grafting

Abstract

We performed an open, prospective, randomized, controlled study of the incidence of major organ complications in 420 patients undergoing routine coronary artery bypass graft surgery with or without thoracic epidural anesthesia and analgesia (TEA). All patients received a standardized general anesthetic. Group TEA received TEA for 96 h. Group GA (general anesthesia) received narcotic analgesia for 72 h. Both groups received supplementary oral analgesia. Twelve patients were excluded-eight in Group TEA and four in Group GA-because of incomplete data collection. New supraventricular arrhythmias occurred in 21 of 206 patients (10.2%) in Group TEA compared with 45 of 202 patients (22.3%) in Group GA (P = 0.0012). Pulmonary function (maximal inspiratory lung volume) was better in Group TEA in a subset of 93 patients (P < 0.0001). Extubation was achieved earlier (P < 0.0001) and with significantly fewer lower respiratory tract infections in Group TEA (TEA = 31 of 206, GA = 59 of 202; P = 0.0007). There were significantly fewer patients with acute confusion (GA = 11 of 202, TEA = 3 of 206; P = 0.031) and acute renal failure (GA = 14 of 202, TEA = 4 of 206; P = 0.016) in the TEA group. The incidence of stroke was insignificantly less in the TEA group (GA = 6 of 202, TEA = 2 of 206; P = 0.17). There were no neurologic complications associated with the use of TEA. We conclude that continuous TEA significantly improves the quality of recovery after coronary artery bypass graft surgery compared with conventional narcotic analgesia.

Acute kidney injury following total joint arthroplasty: retrospective analysis

“…Epidural analgesia has been shown to have a renal protective effect in patients undergoing coronary artery bypass grafting surgery. 29 Though neuraxial anesthesia has little effect on renal blood flow or urine output, 30 it does blunt the sympathetic response to surgery, and this has been postulated to be the mechanism of renal protection in open heart surgery. 29 Our study design was not designed to elicit the ''protective'' effect of this technique.…”

“…29 Though neuraxial anesthesia has little effect on renal blood flow or urine output, 30 it does blunt the sympathetic response to surgery, and this has been postulated to be the mechanism of renal protection in open heart surgery. 29 Our study design was not designed to elicit the ''protective'' effect of this technique. It should be emphasized that most patients had peripheral nerve blocks regardless of the primary anesthetic.…”

Clinical results with a new acoustic device to identify the epidural space

“…The advantages of using saline instead of air to perform an epidural puncture are documented in the literature [11][12][13]. The clinical advantages of epidural anaesthesia are well established [1][2][3]. Recent developments to enhance safety of the epidural procedure have been in the fields of needle design, pharmacology and correct positioning of the epidural needle [8,[14][15][16].…”

“…It has been shown to lead to greater patient satisfaction, shorter hospital stays and therefore lower costs [1][2][3].…”

Ultra-fast-track anesthesia in off-pump coronary artery bypass grafting: a prospective audit comparing opioid-based anesthesia vs thoracic epiduralbased anesthesia

“…Thoracic epidural analgesia (TEA) is advantageous as adjunctive anesthesia and analgesia to fast-track patients after cardiac surgery [1][2][3] with superior pain management, [4][5][6][7][8][9] reduced opioid requirements, improved pulmonary function, 10,11 and myocardial protection. 12,13 Maintenance of body temperature is an important factor in achieving immediate extubation after OPCAB as shown by a recent retrospective study of ten patients, who were extubated in the operating theatre after OPCAB.…”