RESEARCH ARTICLE


High Thoracic Epidural Analgesia as an Adjunct to General Anesthesia in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting Alternate Title: High Thoracic Epidural Analgesia



Erdem Cetin1, *, Alper Iynem2, Celal Selcuk Unal1, Ertan Demirdas3
1 Department of Cardiovascular Surgery, Karabuk University Education and Research Hospital, Karabuk, Turkey
2 Department of Anesthesiology, Medikar Hospital, Karabuk, Turkey
3 Departmant of Cardiovascular Surgery, Gulhane Education and Research Hospital, Ankara, Turkey


Article Metrics

CrossRef Citations:
0
Total Statistics:

Full-Text HTML Views: 4121
Abstract HTML Views: 2068
PDF Downloads: 1455
ePub Downloads: 874
Total Views/Downloads: 8518
Unique Statistics:

Full-Text HTML Views: 1942
Abstract HTML Views: 1001
PDF Downloads: 918
ePub Downloads: 525
Total Views/Downloads: 4386



Creative Commons License
© 2019 Cetin et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Cardiovascular Surgery, Karabuk University Education and Research Hospital, Sirinevler Mah. Alparslan Cad. No: 1, Karabuk, Turkey;
Tel: 05392905659; E-mail: opdrerdemcetin2018@gmail.com


Abstract

Aim:

To investigate the effect of high thoracic epidural analgesia combined with general anesthesia on pain management and postoperative outcomes in patients undergoing off-pump Coronary Artery Bypass Grafting (CABG).

Materials and Methods:

Patients were divided into two groups; Group 1 received general anesthesia and high thoracic epidural anesthesia whereas Group 2 received general anesthesia alone during off-pump coronary artery bypass grafting. Epidural catheters were placed at least 6 hours before transfer to the operating room. An epidural analgesic solution of 0.25% bupivacaine and 10 µg/ml fentanyl was started as continuous infusion at 5 ml/hour and maintained for at least 12 hours after completion of surgery. A 10-cm visual analog scale was used to measure pain at 4th, 6th, 9th and 12th postoperative hours.

Results:

Mean time to extubation was similar between two groups (2.45±0.88 vs. 2.59±1.31 for Groups 1 and 2, respectively, p=0.90). In all measurements, mean Visual Analogue Scale VAS scores were significantly lower in Group 1 compared to Group 2 (6.50±1.53 vs. 4.09±1.83 at 4th hour, 6.62±1.55 vs. 3.71±1.85 at 6th hour, 5.83±1.40 vs. 2.93±1.54 at 9th hour and 4.41±1.97 vs. 2.50±1.19 at 12th hour, p<0.001 in each comparison).

Conclusion:

Continuous high thoracic epidural analgesia seems to be a good adjunct to general anesthesia, as its pain relief effect becomes obvious at 4th postoperative hour and lasts at least 12th postoperative hour.

Keywords: Coronary artery bypass grafting, High thoracic epidural anesthesia, Pain, Analgesia, Postoperative pain control.