Coronary Artery Disease
Conditions
Keywords
Epidural Analgesia, OPCAB, PCEA
Brief summary
The aim of the present study was to assess the efficacy of thoracic epidural anesthesia followed by postoperative epidural infusion and patient-controlled epidural analgesia with ropivacaine/fentanyl in off-pump coronary artery bypass grafting
Detailed description
Ninety-three patients were scheduled for off-pump coronary artery bypass (OPCAB) under propofol/fentanyl anesthesia. Day before surgery patients were asked for informed consent and randomized into three postoperative analgesia regimens aiming at a visual analog scale (VAS) score \<30 mm at rest. The control group (n=31) received intravenous fentanyl 10 µg/ml postoperatively 3-8 mL/h. After placement of an epidural catheter at the level of Th2-Th4 before OPCAB, a thoracic epidural infusion (EI) group (n=31) received epidural anesthesia (EA) intraoperatively with ropivacaine 0.75% 1 mg/kg and fentanyl 1 µg/kg followed by continuous EI of ropivacaine 0.2% 3-8 mL/h and fentanyl 2 µg/mL postoperatively. The patient-controlled epidural analgesia (PCEA) group (n=31), in addition to EA and EI, received PCEA (ropivacaine/fentanyl bolus 1 mL, lock-out interval 12 min) postoperatively. Hemodynamics and blood gases were measured throughout 24 h after OPCAB.
Interventions
PROCEDUREintravenous analgesia
Patients received postoperative analgesia with intravenous infusion of fentanyl 10 µg/ml 3-8 mL/h
PROCEDUREepidural infusion
Postoperative analgesia was performed using continuous epidural infusion of ropivacaine 0.2% 3-8 mL/h and fentanyl 2 µg/mL
Postoperative analgesia was performed by continuous epidural infusion of ropivacaine/fentanyl mixture combined with patient-controlled epidural analgesia with ropivacaine/fentanyl bolus 1 mL, lock-out interval 12 min.
Sponsors
University of Tromso
Northern State Medical University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* presence of coronary artery disease * ASA II-III * elective off-pump coronary artery bypass
Exclusion criteria
* age \< 18 years * severe valve dysfunction or peripheral vascular disease * simultaneous interventions (carotid endarterectomy, aneurysm repair, etc.) * transfer to CPB during surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Duration of postoperative mechanical ventilation | Participants will be followed for the duration of mechanical ventilation, an expected average of 6 hours | Duration of postoperative mechanical ventilation, hours |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hemodynamic stability | All period of operation and during 24 hours postoperatively | Hemodynamic stability as assessed by mean arterial pressure, heart rate, cardiac index, requirement of inotrops/vasoactives and colloids |
Countries
Russia
Outcome results
None listed