Korean J Anesthesiol.  2004 Oct;47(4):521-526. 10.4097/kjae.2004.47.4.521.

The Effects of High Thoracic Epidural Patient Controlled Analgesia after Open Heart Surgery

• Huh IY
• Sim JY
• Lim YJ
• Choi IC

• KMID: 2299288
• DOI: http://doi.org/10.4097/kjae.2004.47.4.521

Abstract

BACKGROUND: Postoperative pain may be severe after open heart surgery (OHS). High thoracic epidural analgesia may reduce postoperative pain and improve the pulmonary function. We investigated the effect of epidural analgesia after median sternotomy
METHODS
Fifty-six patients were randomized to epidural patient controlled analgesia (PCA) or conventional analgesia (control). Patients received OHS with standardized general anesthetic technique. The day before surgery, patients allocated to the PCA group had an epidural catheter inserted at level T4-5. Proper placement was tested with small dose of lidocaine and epinephrine. Epidural catheter was removed 3 days after surgery. Patients in control group received conventional nurse controlled analgesia. Postoperative assessment included daily visual analog scoring (VAS) and pulmonary function test 3 days after surgery. Complication and patients satisfaction were also evaluated.
RESULTS
The VAS scores did not significantly differ between the groups, except 12 hours after surgery during coughing. Patients with PCA awoke and were extubated significantly earlier than patients in control group. Significantly higher forced expiratory volume in 1s and peak expiratory flow rate were seen in PCA group than in control group. No significant thoracic epidural related complications occurred.
CONCLUSIONS
Thoracic epidural PCA provided better analgesia and allowed earlier extubation. Thoracic epidural PCA yields a slight, but significant, improvement in pulmonary function.

Keyword

open heart surgery; epidural patient controlled analgesia

MeSH Terms

Analgesia
Analgesia, Epidural
Analgesia, Patient-Controlled*
Catheters
Cough
Epinephrine
Forced Expiratory Volume
Heart*
Humans
Lidocaine
Pain, Postoperative
Passive Cutaneous Anaphylaxis
Peak Expiratory Flow Rate
Respiratory Function Tests
Sternotomy
Thoracic Surgery*
Epinephrine
Lidocaine