Thoracic Epidural Anesthesia Improves Early Outcomes in Patients Undergoing Off-pump Coronary Artery Bypass Surgery

Abstract

Background:The aim of this two-center, open, randomized, controlled trial was to evaluate the impact of thoracic epidural anesthesia on early clinical outcomes in patients undergoing off-pump coronary artery bypass surgery. Methods: Two hundred and twenty-six patients were randomized to either general anesthesia plus epidural (GAE) (n ϭ 109) or general anesthesia only (GA) (n ϭ 117). The primary outcome was length of postoperative hospital stay. Secondary outcomes were: arrhythmia, inotropic support, intubation time, perioperative myocardial infarction, neurologic events, intensive care stay, pain scores, and analgesia requirement. Results: Baseline characteristics were similar in the two groups. One patient died in the GAE group. Median postoperative stay was significantly reduced in the GAE, com-

A prospective randomized study of intraoperative thoracic epidural analgesia in off-pump coronary artery bypass surgery

“…Recently, a prospective, randomized, controlled trial [26] has shown that the addition of TEA to conventional GA accounts for a significant reduction in the incidence of postoperative arrhythmias, and an improvement in the overall quality of recovery, allowing earlier tracheal extubation and earlier hospital discharge. In our study, GA plus TEA had no impact on the outcomes of OPCABs, while it lead to a higher requirement for vasoactive drug use.…”

Perioperative Organ Protection in Cardiac Surgery

“…Analgesia with spinal opioids showed no effect on mortality, incidence of myocardial infarction, arrhythmias, mortality and duration of intubation when compared with general anesthesia (47). In patients undergoing off-pump coronary artery bypass surgery, the addition of thoracic epidural to general anesthesia can reduce the incidence of postoperative arrhythmias and improves pain control and overall quality of recovery, allowing earlier extubation and hospital discharge (48).…”

On- or Off-Pump Coronary Artery Bypass: What Is the Evidence?

“…Equal success has been achieved using both thoracic epidural anesthesia and general anesthesia techniques for OPCAB surgery (40,(47)(48)(49). OP-CAB with thoracic epidural anesthesia allows efficient cerebral blood flow management, reduces the rate of postoperative arrhythmias, and improves pain control with overall satisfactory recovery (45).…”