Comparison of three different epidural solutions in off-pump cardiac surgery: pilot study

Olivier, J; Lê, Nhiên; Choinière, Jean-Luc; Prieto, Ignatio; Basile, Fadi; Hemmerling, Thomas M.

doi:10.1093/bja/aei238

Cited by 17 publications

(5 citation statements)

References 18 publications

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“…Concern has been described about the possible effect of clonidine addition in epidural infusions because of the possible effect on the blood pressure. Whereas one recent study [34] showed lower blood pressure when clonidine was added to ropivacaine for epidural analgesia after spinal anesthesia, we could not support these findings in a previous study with the same study setup [35,36] Although this was not the main focus of the study, perioperative blood pressure and heart rate remained stable and was not different between the three groups.…”

Section: Clonidine In Epidural Administrationcontrasting

confidence: 79%

Comparison of Three Different Epidural Solutions in Cardiac Surgery for Stress Protection

Jean-François¹,

Prieto²,

Basile³

et al. 2009

TOATJ

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Background: Different solutions are possible for thoracic epidural analgesia in cardiac surgery. So far, local anesthetics alone or in combination with either clonidine or opioids have been used. Aims:To determine the stress protection provided by different epidural solutions throughout cardiac surgery.Study Design: A randomized, prospective, double blind study in patients undergoing off-pump coronary artery bypass grafting (OPCAB), randomized in three different groups. Thoracic epidural analgesia was installed more than 1 h before application of heparin at levels of T2 to T4; analgesia was provided by 8 ml of bupivacaine 0.25% 15 min prior to surgery and extubation, and 10 ml/h during and up to 72 h after surgery using one of the following regimens: bupivacaine 0.125% solely, bupivacaine 0.125% with fentanyl 3 g/mL or bupivacaine 0.125% with clonidine 0.6 g/mL. Patients were blockrandomized for one of the three treatments. Cortisol and glucose values were determined before surgery, at extubation and 1h and 3h after surgery. Pain scores were assessed up to 48 h after surgery. Hemodynamic stability was also recorded in form of heart rate, systolic and diastolic blood pressure. Multi-comparison ANOVA and Chi-square test were used to compare the data, presented as mean (SD) or median (25 th and 75 th percentile), P < 0.05.Study Setting: A cardiac surgery unit at a tertiary university hospital.Participants: Forty-two patients undergoing OPCAB were enrolled.Main Results: All patient data as well hemodynamic stability were not different between the three groups. All patients were successfully extubated in theatre immediately after surgery. Pain control was good and not significantly different between the groups. Mean glucose concentrations ± SD before surgery and (significantly higher) 3h after surgery were 5.4 ± 1.0 mmol l -1 and 8.4 ± 1.6 mmol l -1 for bupivacaine alone, 5.2 ± 0.5 mmol l -1 and 8.5 ± 2.2 mmol l -1 for bupivacaine plus fentanyl and 5.5 ± 1.6 mmol l -1 and 9.5 ± 2.1mmol l -1 for bupivacaine and clonidine, respectively. The mean cortisol values ± SD in the pre-operative period and 3h after surgery were 413 ± 162 nmol l -1 and 562 ± 173 nmol l -1 for bupivacaine alone, 393 ± 107 nmol l -1 and 581 ± 265 nmol l -1 for bupivacaine and fentanyl and 409 ± 159 nmol l -1 and 570 ± 160 nmol l -1 for bupivacaine and clonidine, respectively. There were no significant differences between the groups. Conclusions:We conclude that short-term stress protection with TEA is equally effective with solely bupivacaine, bupivacaine with fentanyl or clonidine.

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Section: Clonidine In Epidural Administrationcontrasting

confidence: 79%

Comparison of Three Different Epidural Solutions in Cardiac Surgery for Stress Protection

Jean-François¹,

Prieto²,

Basile³

et al. 2009

TOATJ

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“…Thoracic epidural analgesia (TEA) with general anesthesia (GA) can provide high-quality analgesia and quick rehabilitation when IE was done with TEA along with GA.[ 2 ] It also ensures hemodynamic stability and allows early extubation. [ 12 ] Nonetheless, it is not essential to obtain optimal results in UFTA,[ 11 ] and the less invasive cardiac anesthesia is promising as well. [ 13 ]…”

Section: Discussionmentioning

confidence: 99%

Comparison of immediate extubation versus ultrafast tracking strategy in the management of off-pump coronary artery bypass surgery

Nagre

Jambures

2018

Ann Card Anaesth

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“…Continuous infusion of low concentration of local anaesthetics avoids motor blockade and spare autonomic function to the urinary bladder, carries no significant toxicity and requires minimal attention from the staff in the ward. [8,9,10] Thus Elastomeric pump which represents a technologic advance in late 80s is relatively inexpensive disposable non mechanical pump may be proposed to provide epidural, perineural, direct wound and intra-articular local anaesthetics infusion for post-operative pain relief. [ 11,12 ] The pump had a capacity of 125ml and was designed to deliver drug @ 5ml/hour for 24 hours continuously.…”

Section: Discussionmentioning

confidence: 99%

Disposable Non-Mechanical Elastomeric Balloon Pump for Continuous Epidural Infusion: An Effective and Reliable Means for Postoperative Analgesia

Saloi¹,

Taye²,

Paul³

2016

jemds

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Postoperative pain an unpleasant sensory and emotional experience is one of the most challenging and gratifying domains to treat. Aim is here to assess effectiveness of postoperative pain relief, side effects and complications while using non-mechanical disposable elastomeric pump as continuous epidural infusion. PATIENTS AND METHODSThe present study has been carried out on thirty patients in postoperative wards. At the end of operation the Elastomeric pump containing 125ml of bupivacaine (0.125%) was connected with the epidural catheter Pain was assessed by VAS scoring system ranging from 0 to 10. Haemodynamic parameters, quality of analgesia, degree of motor block, and adverse effect encountered were recorded at two hours interval for 24 hours at the end of two hours of subarachnoid block when operation is over. RESULTS AND OBSERVATIONSNone of our patients had shown any clinically significant changes in their cardiorespiratory indices in the postoperative period. All the patients at 0 hr. were having VAS score of 0 and till 22 hours enjoyed good pain relief, i.e. VAS of 3-4. Infusion is not always steady as set by the manufacturer. There is no motor blockade after 16 hours (Bromage-0). Insignificant number of patients experienced nausea or vomiting and backache. CONCLUSIONSElastomeric balloon pumps is a reliable device to deliver LA agents steadily and safely with 0.125% bupivacaine as continuous epidural.

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Comparison of three different epidural solutions in off-pump cardiac surgery: pilot study

Abstract: We conclude that immediate extubation after OPCAB using TEA is feasible with different TEA regimens. Respiratory function, haemodynamic stability and pain control are not different between TEA with bupivacaine alone, bupivacaine with fentanyl or bupivacaine with clonidine.

Cited by 17 publications

References 18 publications

Comparison of Three Different Epidural Solutions in Cardiac Surgery for Stress Protection

Comparison of Three Different Epidural Solutions in Cardiac Surgery for Stress Protection

Comparison of immediate extubation versus ultrafast tracking strategy in the management of off-pump coronary artery bypass surgery

Disposable Non-Mechanical Elastomeric Balloon Pump for Continuous Epidural Infusion: An Effective and Reliable Means for Postoperative Analgesia

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