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REGIONAL ANESTHESIA AND PAIN MEDICINE

The Effects of Thoracic Epidural Analgesia with Bupivacaine 0.25% on Ventilatory Mechanics in Patients with Severe Chronic Obstructive Pulmonary Disease

Eva M. Gruber, MD^*, Edda M. Tschernko, MD^*, Meinhard Kritzinger, MD^*, Elena Deviatko, MD, Wilfried Wisser, MD, David Zurakowski, PhD, and Wolfram Haider, MD^*

Department of *Cardiothoracic and Vascular Anesthesia & Intensive Care Medicine and Cardiothoracic Surgery, University of Vienna, Vienna, Austria; Department of Biostatistics, Harvard Medical School, Boston, Massachusetts

Address and correspondence and reprint requests to Edda M. Tschernko, MD, Department of Cardiothoracic Anesthesia & Intensive Care Medicine, Vienna General Hospital, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. Address e-mail to edda.tschernko{at}univie.ac.at

Optimal analgesia is important after thoracotomy in pulmonary-limited patients to avoid pain-related pulmonary complications. Thoracic epidural anesthesia (TEA) can provide excellent pain relief. However, potential paralysis of respiratory muscles and changes in bronchial tone might be unfavorable in patients with end-stage chronic obstructive pulmonary disease (COPD). Therefore, we evaluated the effect of TEA on maximal inspiratory pressure, pattern of breathing, ventilatory mechanics, and gas exchange in 12 end-stage COPD patients. Pulmonary resistance, work of breathing, dynamic intrinsic positive end-expiratory pressure, and peak inspiratory and expiratory flow rates were evaluated by assessing esophageal pressure and airflow. An increase in minute ventilation (7.50 ± 2.60 vs 8.70 ± 2.10 L/min; P = 0.04) by means of increased tidal volume (0.46 ± 0.16 vs 0.53 ± 0.14 L/breath; P = 0.003) was detected after TEA. These changes were accompanied by an increase in peak inspiratory flow rate (0.48 ± 0.17 vs 0.55 ± 0.14 L/s; P = 0.02) and a decrease in pulmonary resistance (20.7 ± 9.9 vs 16.6 ± 8.1 cm H₂O · L^-1 · s^-1; P = 0.02). Peak expiratory flow rate, dynamic intrinsic positive end-expiratory pressure, work of breathing, PaO₂, and maximal inspiratory pressure were unchanged (all P > 0.50). We conclude that TEA with bupivacaine 0.25% can be used safely in end-stage COPD patients.

Implications: Thoracic epidural anesthesia with bupivacaine 0.25% does not impair ventilatory mechanics and inspiratory respiratory muscle strength in severely limited chronic obstructive pulmonary disease patients. Thus, thoracic epidural anesthesia can be used safely in patients with end-stage chronic obstructive pulmonary disease.

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