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Thoracic epidural analgesia improves pulmonary function in patients undergoing cardiac surgery

L’analgésie péridurale thoracique améliore la fonction pulmonaire chez les patients subissant une chirurgie cardiaque

Abstract

Purpose: Pulmonary dysfunction commonly occurs following coronary artery bypass graft (CABG) surgery, increasing morbidity and mortality. We hypothesized that thoracic epidural anesthesia (TEA) would improve pulmonary function and would decrease complications in patients undergoing CABG surgery.

Methods: This prospective, randomized, controlled trial was conducted with Ethics Board approval. Fifty patients, undergoing CABG surgery, were randomized to the epidural group or to the patient-controlled analgesia morphine group. Patients in the epidural group received a high, thoracic epidural, preoperatively. Intraoperatively, 0.75% ropivacaine was infused, followed postoperatively, by 0.2% ropivacaine for 48 hr. Outcome measurements included: visual analogue pain scores; spirometry; atelectasis scores on chest radiographs; and the incidence of atrial fibrillation.

Results: Twenty-five patients were enrolled in each group. Patients in the epidural group had significantly less pain on the operative day, and for the subsequent two days. Compared to baseline, the forced expiratory volume in one second was significantly higher in the epidural group, on the first and second postoperative days (43.7±12.2%vs 36.4±12.0%,p<0.002, and 43.3±12.5%vs 38.4±11.0%,p<0.05). There was significantly more atelectasis in the control group, four hours postoperatively (p<0.04); however, on the third, postoperative day, the groups were similar with regards to this outcome. The incidence of atrial fibrillation was similar in both groups, and there were no complications related to the epidural.

Conclusions: High TEA decreases postoperative pain and atelectasis and improves pulmonary function in patients undergoing CABG surgery. Our results support the use of TEA in this group of patients.

Résumé

Objectif: Des troubles pulmonaires surviennent fréquemment à la suite d’une chirurgie de pontage aortocoronarien (pAC), ce qui augmente la morbidité et la mortalité. Nous avons émis l’hypothèse que l’anesthésie péridurale thoracique (ApT) améliorerait la fonction pulmonaire et réduirait les complications chez les patients subissant une chirurgie de pAC.

Méthode: Après avoir obtenu l’accord du Comité d’éthique, nous avons mené cette étude prospective, randomisée et contrôlée. Cinquante patients subissant une chirurgie pAC ont été randomisés dans deux groupes, péridurale ou analgésie contrôlée par le patient avec de la morphine. Les patients du groupe péridurale ont reçu une péridurale thoracique haute avant l’opération. pendant l’opération, ils ont reçu une perfusion de ropivacaïne 0,75 %, puis de la ropivacaïne 0,2 % pendant 48 h après l’opération. Les résultats mesurés étaient les scores de douleur sur l’échelle visuelle analogue, la spirométrie, les scores d’atélectasie sur les radiographies pulmonaires et l’incidence de fibrillation auriculaire.

Résultats: Chaque groupe comprenait 25 patients. La douleur chez les patients du groupe péridurale était considérablement moins élevée le jour de l’opération et les deux jours suivants. par rapport aux données de base, le volume expiratoire maximal en une seconde était significativement plus élevé dans le groupe péridurale le premier et le deuxième jour postopératoire (43,7±12,2 % vs 36,4±12,0 %, p<0,002, et 43,3±12,5 % vs 38,4±11,0 %, p<0,05). L’atélectasie a été significativement plus élevée dans le groupe témoin quatre heures après l’opération (p<0,04) ; toutefois, le troisième jour postopératoire, les groupes ont montré des résultats d’atélectasie similaires. L’incidence de fibrillation auriculaire était semblable dans les deux groupes, et il n’y a pas eu de complication associée à la péridurale.

Conclusion: L’analgésie péridurale thoracique haute réduit la douleur postopératoire et l’atélectasie et améliore la fonction pulmonaire chez les patients subissant un pAC. Nos résultats appuient l’utilisation de l’ApT chez ce groupe de patients.

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Author information

Correspondence to Stephen E. Kowalski md frcpc.

Additional information

This project was supported by the Health Sciences Centre Research Foundation.

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Tenenbein, P.K., Debrouwere, R., Maguire, D. et al. Thoracic epidural analgesia improves pulmonary function in patients undergoing cardiac surgery. Can J Anesth 55, 344–350 (2008). https://doi.org/10.1007/BF03021489

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Keywords

  • Coronary Artery Bypass Graft
  • Ropivacaine
  • Mean Arterial Blood Pressure
  • Epidural Catheter
  • Visual Analogue Scale Pain Score