title: Comparison of three different epidural solutions in off-pump cardiac surgery: pilot study.
abstract: BACKGROUND
  Immediate extubation using thoracic epidural analgesia (TEA) has become more popular after off-pump coronary artery bypass grafting (OPCAB). In this randomized prospective double-blind study, we present the first comparison of preoperative and postoperative haemodynamics during different regimens of TEA for immediate extubation after cardiac surgery.
  
  
  METHODS
  Sixty patients undergoing OPCAB were enrolled in this study. TEA was installed >1 h before application of heparin at levels T2-T4. Analgesia was provided by bupivacaine 0.25%, 8 ml, 15 min before surgery and extubation, and at 10 ml h(-1) during surgery and up to 72 h afterwards using one of the following regimens: bupivacaine 0.125% alone, bupivacaine 0.125% with fentanyl 3 microg ml(-1) or bupivacaine 0.125% with clonidine 0.6 microg ml(-1). Patients were block-randomized for one of the three treatments. Pain scores and infusion rates of TEA were assessed up to 48 h after surgery. Respiratory function was assessed by Pa(o2) and Pa(o2) immediately after surgery, and haemodynamic stability was recorded in the form of heart rate and diastolic and systolic blood pressure.
  
  
  RESULTS
  Patient characteristics, respiratory function and haemodynamic stability did not vary between the three groups. Pain control was very good and was not significantly different between the groups using similar infusion rates after surgery. Paraesthesia in dermatomes T1 or C8 occurred equally in all three groups. There was no neurological complication related to TEA in this study.
  
  
  CONCLUSIONS
  We conclude that immediate extubation after OPCAB using TEA is feasible with different TEA regimens. Respiratory function, haemodynamic stability and pain control are not different between TEA with bupivacaine alone, bupivacaine with fentanyl or bupivacaine with clonidine.
authors.affiliation: Perioperative Cardiac Research Group, Department of Anesthesiology, Hôtel-Dieu, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
authors.forename: J F
authors.initials: JF
authors.lastname: Olivier
authors.forename: N
authors.initials: N
authors.lastname: Le
authors.forename: J L
authors.initials: JL
authors.lastname: Choinière
authors.forename: I
authors.initials: I
authors.lastname: Prieto
authors.forename: F
authors.initials: F
authors.lastname: Basile
authors.forename: T
authors.initials: T
authors.lastname: Hemmerling
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000379:methods*; D000779:Anesthetics, Local; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine; D003000:Clonidine; D047549:Coronary Artery Bypass, Off-Pump; D020878:Device Removal; D004812:Epidemiologic Methods; D005260:Female; D005283:Fentanyl; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control; D010313:Partial Pressure
chemical_list: D000779:Anesthetics, Local; D003000:Clonidine; D010100:Oxygen; D005283:Fentanyl; D002045:Bupivacaine