Association of thoracic epidural analgesia with risk of atrial arrhythmias after pulmonary resection: a retrospective cohort study

Abstract

Purpose Atrial arrhythmias are common after non-cardiac thoracic surgery. We tested the hypothesis that TEA reduces the risk of new-onset atrial arrhythmias after pulmonary resection. Methods We evaluated patients who had pulmonary resection. New-onset atrial arrhythmias detected before hospital discharge was our primary outcome. Secondary outcomes included other cardiovascular complications, pulmonary complications, time-weighted average pain score over 72 h, and duration of hospitalization. Patients with combination of general anesthesia and TEA were matched on propensity scores with patients given general anesthesia only. The matched groups were compared by use of logistic regression, linear regression, or Cox proportional hazards regression, as appropriate. Results Among 1,236 patients who had pulmonary resections, 937 received a combination of general anesthesia and TEA (TEA) and 299 received general anesthesia only (non-TEA). We successfully matched 311 TEA patients with 132 non-TEA patients. We did not find a significant association between TEA and postoperative atrial arrhythmia (odds ratio (95 % CI) of 1.05 (0.50, 2.19), P = 0.9). TEA was not significantly associated with length of hospital stay or postoperative pulmonary complications (odds ratio (95 % CI) of 0.71 (0.22, 2.29), P = 0.47). TEA patients experienced fewer postoperative cardiovascular complications; although the association was not statistically significant (odds ratio (95 % CI) of 0.30 (0.06, 1.45), P = 0.06). Time-weighted average pain scores were similar in the two groups. Conclusion TEA was not associated with reduced occurrence of postoperative atrial arrhythmia. Although postoperative pulmonary complications were similar with and without TEA, TEA patients tended to experience fewer cardiovascular complications.

Potentially modifiable risk factors for atrial fibrillation following lung resection surgery: a retrospective cohort study

“…Direct sympathetic nerve block by epidural analgesia is thought to be the reason why it reduces postoperative tachyarrhythmias in cardiac surgery . However, the anti‐arrhythmic effect of epidural analgesia is debatable in thoracic surgery . Blockade at the level of T1–T4 is required for cardiac sympathetic fibres.…”

Acute Pain Burden and Opioid Dose Requirements after Cesarean Delivery in Parturients with Preexisting Chronic Back Pain and Migraine

“…The pain score reported was at the body locations relevant for postcesarean delivery (i.e., incisional pain, abdominal pain, and pelvic pain). TWA pain score was equal to the sum of the portion of each time interval in between two adjacent pain score measurements multiplied by the average of the corresponding two pain scores that was then divided by the time interval between the first and the last pain score measurements [ 13 , 14 ]. Therefore, it could be calculated even if the pain scores were not reported every 4 hours or the pain scores were not reported for certain periods of time [ 14 ].…”

“…TWA pain score was equal to the sum of the portion of each time interval in between two adjacent pain score measurements multiplied by the average of the corresponding two pain scores that was then divided by the time interval between the first and the last pain score measurements [ 13 , 14 ]. Therefore, it could be calculated even if the pain scores were not reported every 4 hours or the pain scores were not reported for certain periods of time [ 14 ]. TWA pain score was calculated from all the available pain scores during the postoperative 48-hour study period.…”

Exploring postoperative atrial fibrillation after non-cardiac surgery: mechanisms, risk factors, and prevention strategies

“…In a study conducted by Komatsu et al, it was observed that the use of epidural analgesia did not yield a statistically significant reduction in the incidence of POAF compared to general anesthesia during pulmonary resection. However, patients receiving epidural analgesia tended to experience fewer postoperative cardiovascular complications ( 95 ). Similarly, in patients undergoing major abdominal surgery with a history of myocardial injury, thoracic segment epidural analgesia was found to reduce the occurrence of arrhythmias, including AF ( 96 ).…”