Lumbar versus thoracic epidural buprenorphine for postoperative analgesia following coronary artery bypass graft surgery.
BACKGROUND
Thoracic epidural analgesia (TEA) is reported to provide effective analgesia following cardiac surgery. We compared the effect of buprenorphine (BN) through the lumbar and thoracic epidural routes for postoperative analgesia following coronary artery bypass graft surgery (CABG).


METHODS
Forty patients with normal left ventricular ejection fraction scheduled for CABG were randomly divided into two groups, the TEA group (n = 19) and the lumbar epidural analgesia (LEA) group (n = 20). For postoperative pain relief they received epidural BN 0.15 mg at the first demand for pain relief following extubation. A top-up dose of BN 0.15 mg was administered in cases where visual analogue scale (VAS) score was > 3 at 1 h after first dose. Subsequent breakthrough pain was treated with 30 mg intramuscular ketorolac tromethamine (ketorolac). Pain assessed by VAS score on a 0-10 scale, respiratory rate, FEV1, FVC, mean arterial blood pressure, cardiac index, PaO2 and PaCO2 were measured at frequent intervals. Side effects of epidural opioids were noted.


RESULTS
Both groups were comparable in demographic characteristics, had similar VAS scores from 1 to 24 h postoperatively, required similar amounts of intramuscular ketorolac for break-through pain and had comparable pulmonary functions and side effects.


CONCLUSIONS
This study shows that BN by the lumbar epidural route for analgesia after CABG compares favourably with the same drug through the thoracic route in terms of quality of analgesia and incidence of side effects.
Mehta
Y
Y
Department of Anaesthesia and Cardiac Surgery, Escorts Heart Institute and Research Centre, New Delhi, India.
Juneja
R
R
Madhok
H
H
Trehan
N
N
D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods*; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002047:Buprenorphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002245:Carbon Dioxide / Q000097:blood; D002302:Cardiac Output / Q000187:drug effects; D001026:Coronary Artery Bypass / Q000009:adverse effects; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D007273:Injections, Intramuscular; D020911:Ketorolac Tromethamine; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D012119:Respiration / Q000187:drug effects; D013318:Stroke Volume; D013904:Thoracic Vertebrae; D014046:Tolmetin / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D014325:Tromethamine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D016277:Ventricular Function, Left; D014797:Vital Capacity / Q000187:drug effects
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D014325:Tromethamine; D002245:Carbon Dioxide; D002047:Buprenorphine; D020911:Ketorolac Tromethamine; D014046:Tolmetin; D010100:Oxygen