| JOURNAL HOME | CME HOME | THIS MONTH | PAST ISSUES | ETOC | COLLECTIONS |
| AUTHORS | REVIEWERS | EDITORIAL BOARD | FEEDBACK | RSS | HELP |
| ||||||||||||||
| ||||||||||||||
|
|
|
|
||||||||||||
|
||||||||||||||
Departments of *Anaesthesia, Cardiothoracic Surgery, and Cardiology, Westmead Hospital, Westmead, Australia
Address correspondence and reprint requests to Mark Priestley, Department of Anaesthesia, Westmead Hospital, Westmead NSW 2145, Sydney, Australia.
Improvements in analgesia after major surgery may allow a more rapid recovery and shorter hospital stay. We performed a prospective randomized trial to study the effects of epidural analgesia on the length of hospital stay after coronary artery surgery. The anesthetic technique and postoperative mobilization were altered to facilitate early intensive care discharge and hospital discharge. Fifty patients received high (T1 to T4) thoracic epidural anesthesia (TEA) with ropivacaine 1% (4-mL bolus, 3–5 mL/h infusion), with fentanyl (100-µg bolus, 15–25 µg/h infusion) and a propofol infusion (6 mg · kg-1 · h-1). Another 50 patients (the General Anesthesia group) received fentanyl 15 µg/kg and propofol (5 mg · kg-1 · h-1), followed by IV morphine patient-controlled analgesia. The TEA group had lower visual analog scores with coughing postextubation (median, 0 vs 26 mm; P < 0.0001) and were extubated earlier (median hours [interquartile range], 3.2 [2.1–4.6] vs 6.7 [3.3–13.2]; P < 0.0001). More than half of all patients were discharged home on Postoperative Day 4 (24%) or 5 (33%), but there was no difference in the length of stay between the TEA group (median [interquartile range], Day 5 [5–6]) and the General Anesthesia group (median [interquartile range], Day 5 [4–7]). There were no differences in postoperative spirometry or chest radiograph changes or in markers for postoperative myocardial ischemia or infarction. No significant TEA-related complications occurred. In summary, TEA provided better analgesia and allowed earlier tracheal extubation but did not reduce the length of hospital stay after coronary artery surgery.
IMPLICATIONS: We found that epidural analgesia was more effective than IV morphine for cardiac surgery. Epidural anesthesia also allowed earlier weaning from mechanical ventilation, but it did not affect hospital discharge time.
This article has been cited by other articles:
|
|
 |
|
  M. Caputo, H. Alwair, C. A. Rogers, M. Ginty, C. Monk, S. Tomkins, A. Mokhtari, and G. D. Angelini Myocardial, Inflammatory, and Stress Responses in Off-Pump Coronary Artery Bypass Graft Surgery With Thoracic Epidural Anesthesia Ann. Thorac. Surg., April 1, 2009; 87(4): 1119 - 1126. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. M. Popping, N. Elia, E. Marret, C. Remy, and M. R. Tramer Protective Effects of Epidural Analgesia on Pulmonary Complications After Abdominal and Thoracic Surgery: A Meta-Analysis Arch Surg, October 1, 2008; 143(10): 990 - 999. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Ronald, K. A. AbdulAziz, T. George Day, and M. Scott In patients undergoing cardiac surgery, thoracic epidural analgesia combined with general anaesthesia results in faster recovery and fewer complications but does not affect length of hospital stay Interactive CardioVascular and Thoracic Surgery, June 1, 2006; 5(3): 207 - 216. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Chaney Intrathecal and Epidural Anesthesia and Analgesia for Cardiac Surgery Anesth. Analg., January 1, 2006; 102(1): 45 - 64. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. F. Olivier, N. Le, J. L. Choiniere, I. Prieto, F. Basile, and T. Hemmerling Comparison of three different epidural solutions in off-pump cardiac surgery: pilot study Br. J. Anaesth., November 1, 2005; 95(5): 685 - 691. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Barrington, R. Kluger, R. Watson, D. A. Scott, and K. J. Harris Epidural Anesthesia for Coronary Artery Bypass Surgery Compared with General Anesthesia Alone Does Not Reduce Biochemical Markers of Myocardial Damage Anesth. Analg., April 1, 2005; 100(4): 921 - 928. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. S. Myles and D. McIlroy Fast-Track Cardiac Anesthesia: Choice of Anesthetic Agents and Techniques Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2005; 9(1): 5 - 16. [Abstract] [PDF]
|
|
|
|
|
|
G. Djaiani, L. Fedorko, and W. S. Beattie Regional Anesthesia in Cardiac Surgery: A Friend or A Foe? Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2005; 9(1): 87 - 104. [Abstract] [PDF]
|
|
|
|
|
|
C. Weissman Pulmonary Complications After Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2004; 8(3): 185 - 211. [Abstract] [PDF]
|
|
|
|
|
|
D. A. Rosen, D. W. Hawkinberry II, K. R. Rosen, R. A. Gustafson, J. P. Hogg, and L. M. Broadman An Epidural Hematoma in an Adolescent Patient After Cardiac Surgery Anesth. Analg., April 1, 2004; 98(4): 966 - 969. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. M. Schwann and M. A. Chaney No pain, much gain? J. Thorac. Cardiovasc. Surg., November 1, 2003; 126(5): 1261 - 1264. [Full Text] [PDF]
|
|
|
|
 |
|
 J. C.Y. Lu, A. D. Grayson, P. Jha, A. K. Srinivasan, and B. M. Fabri Risk factors for sternal wound infection and mid-term survival following coronary artery bypass surgery Eur. J. Cardiothorac. Surg., June 1, 2003; 23(6): 943 - 949. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Schachner, J. Bonatti, D. Balogh, J. Margreiter, P. Mair, G. Laufer, and G. Putz Aortic valve replacement in the conscious patient under regional anesthesia without endotracheal intubation J. Thorac. Cardiovasc. Surg., June 1, 2003; 125(6): 1526 - 1527. [Full Text] [PDF]
|
|
|
