Effect of thoracic epidural analgesia on refractory angina pectoris: long-term home self-treatment.
OBJECTIVE
To evaluate the effects of long-term home self-treatment with thoracic epidural analgesia (TEA) on angina, quality of life, and safety.


METHODS
Prospective consecutive pilot study.


METHODS
Department of Cardiology, Heart Center, Linköping University Hospital.


METHODS
Between January 1998 and January 2000, 37 consecutive patients with refractory angina began treatment with TEA, using a subcutaneously tunnelled epidural catheter.


METHODS
The patients were trained to provide self-treatment at home with intermittent injections of bupivacaine. Data were collected until January 2001, and the follow-up for each patient was 1 to 3 years.


RESULTS
All but 1 of the patients improved symptomatically. The improvement was maintained throughout the treatment period (4 days to 3 years). The Canadian Cardiovascular Society angina class decreased from 3.6 to 1.7, frequency of anginal attacks decreased from 46 to 7 a week, nitroglycerin intake decreased from 32 to 5 a week, and the overall self-rated quality of life assessed by visual analog scale increased from 24 to 76 (all p < 0.001). No serious catheter-related complications occurred; however, 51% of the catheters became displaced and a new one had to be inserted during the study.


CONCLUSIONS
Long-term self-administered home treatment with TEA seems to be an effective and safe adjuvant treatment for patients with refractory angina. It produces symptomatic relief of angina and improves the quality of life.
Richter
Arina
A
Department of Cardiology, Heart Center, University Hospital, Linköping, Sweden. arina.richter@lio.se
Cederholm
Ingemar
I
Jonasson
Lena
L
Mucchiano
Carlo
C
Uchto
Michael
M
Janerot-Sjöberg
Birgitta
B
D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage; D000787:Angina Pectoris / Q000628:therapy*; D002045:Bupivacaine / Q000008:administration & dosage; D005260:Female; D018575:Home Care Services, Hospital-Based; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D012646:Self Administration
D000779:Anesthetics, Local; D002045:Bupivacaine