OBJECTIVE: To evaluate the effects of thoracic epidural anesthesia (TEA) as an adjunct to general anesthesia (GA) on postoperative painafter coronary artery bypass grafting (CABG). METHODS:Between April 2009 and March 2010, 40 patients with ischemic heart disease scheduled for elective CABG were prospectively randomized to receive either GA (n = 20) or GA + TEA (n = 20). Through epidural catheters, patients received an infusion of (10-20 mg/h) 0.25%-bupivacaine intraoperatively and during the first 24 hours after surgery. Study endpoints included assessment of postoperative pain at rest and with coughing, rescue analgesic need, and postoperative course. RESULTS: The differences in pain scores were decreased at rest during 6 (0.1 ± 0.3 vs. 2.4 ± 1.8; p < 0.05) and 12 hours (0.1 ± 0.3 vs. 3.9 ± 2.3; p < 0.05) and with coughing at 6 (0.1 ± 0.3 vs. 5.6 ± 2.2; p < 0.05), 12 (0.1 ± 0.3 vs. 5.9 ± 2.3; p < 0.05), and 24 hours (0.05 ± 0.2 vs. 4.6 ± 2.9; p < 0.05) in the GA + TEA group. At one-month follow-up, pain scores were decreased in GA + TEA group (0.3 ± 0.7 vs. 1.6 ± 1.3; p = 003). There was no significant difference at three and six months. Mechanical ventilation time (4.7 ± 1.2 vs. 2.9 ± 1.1 hours; p < 0.05), intensive care unit stay (28.4 ± 9.0 vs. 22.4 ± 3.4 hours; p < 0.05), and hospital stay (7.2 ± 1.1 vs. 6.1 ± 0.3 days; p = 0.001) were reduced in the GA + TEA group. CONCLUSIONS:TEA significantly reduced the intensity of postoperative pain and analgesic consumption in the early postoperative period following CABG. The delivery of effective analgesia along with conventional medications may prevent chronic pain after surgery.
RCT Entities:
OBJECTIVE: To evaluate the effects of thoracic epidural anesthesia (TEA) as an adjunct to general anesthesia (GA) on postoperative pain after coronary artery bypass grafting (CABG). METHODS: Between April 2009 and March 2010, 40 patients with ischemic heart disease scheduled for elective CABG were prospectively randomized to receive either GA (n = 20) or GA + TEA (n = 20). Through epidural catheters, patients received an infusion of (10-20 mg/h) 0.25%-bupivacaine intraoperatively and during the first 24 hours after surgery. Study endpoints included assessment of postoperative pain at rest and with coughing, rescue analgesic need, and postoperative course. RESULTS: The differences in pain scores were decreased at rest during 6 (0.1 ± 0.3 vs. 2.4 ± 1.8; p < 0.05) and 12 hours (0.1 ± 0.3 vs. 3.9 ± 2.3; p < 0.05) and with coughing at 6 (0.1 ± 0.3 vs. 5.6 ± 2.2; p < 0.05), 12 (0.1 ± 0.3 vs. 5.9 ± 2.3; p < 0.05), and 24 hours (0.05 ± 0.2 vs. 4.6 ± 2.9; p < 0.05) in the GA + TEA group. At one-month follow-up, pain scores were decreased in GA + TEA group (0.3 ± 0.7 vs. 1.6 ± 1.3; p = 003). There was no significant difference at three and six months. Mechanical ventilation time (4.7 ± 1.2 vs. 2.9 ± 1.1 hours; p < 0.05), intensive care unit stay (28.4 ± 9.0 vs. 22.4 ± 3.4 hours; p < 0.05), and hospital stay (7.2 ± 1.1 vs. 6.1 ± 0.3 days; p = 0.001) were reduced in the GA + TEA group. CONCLUSIONS:TEA significantly reduced the intensity of postoperative pain and analgesic consumption in the early postoperative period following CABG. The delivery of effective analgesia along with conventional medications may prevent chronic pain after surgery.
Authors: Jennifer S Gewandter; Robert H Dworkin; Dennis C Turk; John T Farrar; Roger B Fillingim; Ian Gilron; John D Markman; Anne Louise Oaklander; Michael J Polydefkis; Srinivasa N Raja; James P Robinson; Clifford J Woolf; Dan Ziegler; Michael A Ashburn; Laurie B Burke; Penney Cowan; Steven Z George; Veeraindar Goli; Ole X Graff; Smriti Iyengar; Gary W Jay; Joel Katz; Henrik Kehlet; Rachel A Kitt; Ernest A Kopecky; Richard Malamut; Michael P McDermott; Pamela Palmer; Bob A Rappaport; Christine Rauschkolb; Ilona Steigerwald; Jeffrey Tobias; Gary A Walco Journal: Pain Date: 2015-07 Impact factor: 7.926
Authors: Michael McGillion; Jennifer Yost; Andrew Turner; Duane Bender; Ted Scott; Sandra Carroll; Paul Ritvo; Elizabeth Peter; Andre Lamy; Gill Furze; Kirsten Krull; Valerie Dunlop; Amber Good; Nazari Dvirnik; Debbie Bedini; Frank Naus; Shirley Pettit; Shaunattonie Henry; Christine Probst; Joseph Mills; Elaine Gossage; Irene Travale; Janine Duquette; Christy Taberner; Sanjeev Bhavnani; James S Khan; David Cowan; Eric Romeril; John Lee; Tracey Colella; Manon Choinière; Jason Busse; Joel Katz; J Charles Victor; Jeffrey Hoch; Wanrudee Isaranuwatchai; Sharon Kaasalainen; Salima Ladak; Sheila O'Keefe-McCarthy; Monica Parry; Daniel I Sessler; Michael Stacey; Bonnie Stevens; Robyn Stremler; Lehana Thabane; Judy Watt-Watson; Richard Whitlock; Joy C MacDermid; Marit Leegaard; Robert McKelvie; Michael Hillmer; Lynn Cooper; Gavin Arthur; Krista Sider; Susan Oliver; Karen Boyajian; Mark Farrow; Chris Lawton; Darryl Gamble; Jake Walsh; Mark Field; Sandra LeFort; Wendy Clyne; Maria Ricupero; Laurie Poole; Karsten Russell-Wood; Michael Weber; Jolene McNeil; Robyn Alpert; Sarah Sharpe; Sue Bhella; David Mohajer; Sem Ponnambalam; Naeem Lakhani; Rabia Khan; Peter Liu; P J Devereaux Journal: JMIR Res Protoc Date: 2016-08-01