title: Thoracic epidural bupivacaine attenuates supraventricular tachyarrhythmias after pulmonary resection.
abstract: Supraventricular tachyarrhythmias after pulmonary surgery are well described. Some investigators suggest that tachyarrhythmias after thoracic operations may result from the relative sympathotonic status produced by injury to the cardiac parasympathetic nerves. We examined whether postoperative thoracic sympathetic blockade by thoracic epidural bupivacaine might reduce the tachyarrhythmias after pulmonary resection. Fifty patients with lung cancer were randomized to receive epidural bupivacaine (Group B) or epidural morphine (Group M). Patients in Group B were given 6 to 10 mL of 0.25% bupivacaine epidurally, followed by epidural infusion at 3 to 5 mL/h for 3 days, and patients in Group M were given 2 to 3 mg morphine epidurally, followed by morphine infusion at a rate of 0.2 mg/h. Tachyarrhythmias were diagnosed by using the continuous heart rate trend and arrhythmia trend with a central monitoring system. Postoperative analgesia was not statistically different between groups. However, the incidence of postoperative tachyarrhythmias in Group B was significantly less than in Group M (1 of 23 vs 7 of 25, P = 0.0497, Fisher's exact test). The continuous infusion of thoracic epidural bupivacaine can reduce supraventricular tachyarrhythmias compared with epidural morphine infusion, presumably because of attenuation of the sympathotonic status after pulmonary resection.
  
  
  CONCLUSIONS
  We examined whether postoperative thoracic sympathetic blockade by thoracic epidural bupivacaine after pulmonary resection might reduce the tachyarrhythmias that may result from the relative sympathotonic status produced by injury to the cardiac parasympathetic nerves. The continuous infusion of thoracic epidural bupivacaine was shown to reduce supraventricular tachyarrhythmias.
authors.affiliation: Division of Anesthesia, Tochigi Cancer Center Hospital, 4-9-13 Yohnan, Utsonomiya-shi, Tochigi 320-0834, Japan. toka@tcc.pref.tochigi.jp
authors.forename: T
authors.initials: T
authors.lastname: Oka
authors.forename: Y
authors.initials: Y
authors.lastname: Ozawa
authors.forename: Y
authors.initials: Y
authors.lastname: Ohkubo
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural; D000779:Anesthetics, Local / Q000494:pharmacology*; D002045:Bupivacaine / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000494:pharmacology; D011013:Pneumonectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D013617:Tachycardia, Supraventricular / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000779:Anesthetics, Local; D009020:Morphine; D002045:Bupivacaine