title: Control of pain through epidural block and incidence of cardiac dysrhythmias in postoperative period of thoracic and major abdominal surgical procedures: a comparative study.
abstract: OBJECTIVE
  Upper abdomen and thorax surgeries cause intense pain. Some of postoperative pain main complications are cardiocirculatory complications. The objective of this study was to test the hypothesis that postoperative analgesia with employment of local anesthetics plus spinal opioids may reduce the incidence of cardiovascular complications in postoperative period of patients in these conditions, comparing with classical methods of postoperative analgesia, opioids and NSAIDs, administered upon patient's demand.
  
  
  METHODS
  Eighty adult patients, ASA I and II, without ECG alterations, were allocated into two groups of 40: Group A, patients under general anesthesia with propofol, cisatracurium and isoflurane, associated with epidural anesthesia with catheter and control of postoperative analgesia with bupivacaine and epidural morphine; and Group B, patients under general anesthesia with the same drugs and doses of A, plus postoperative analgesia carried out with NSAIDs and intravenous morphine at the end of surgery and in regular intervals. In both groups Holter was applied for 24 hours. Pain evaluation was carried out through visual analog scale.
  
  
  RESULTS
  In pain evaluation, an evident predominance of 0 score (p<0.001) was observed in Group A and there was also reduction of blood pressure levels in postoperative period in a more accentuated way. Ventricular and supraventricular dysrhythmias were five times more frequent in Group B (p=0.00001), in which a tendency to a higher frequency of ventricular extrasystoles in age>50 years (22.2% versus 0.0%. p=0.26) was also detected. No significative difference of heart rate among groups (p>0.05) was observed.
  
  
  CONCLUSIONS
  The best quality of analgesia in postoperative period, carried out in Group A, reduced the incidence of cardiovascular complications.
authors.affiliation: Universidade Federal do Paraná (UFPR), Brazil. rohnelt_oliveira@uol.com.br
authors.forename: Rohnelt Machado
authors.initials: RM
authors.lastname: de Oliveira
authors.forename: Sérgio Bernardo
authors.initials: SB
authors.lastname: Tenório
authors.forename: Pedro Paulo
authors.initials: PP
authors.lastname: Tanaka
authors.forename: Dalton
authors.initials: D
authors.lastname: Precoma
mesh_terms: D000005:Abdomen / Q000601:surgery*; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000150:complications* / Q000517:prevention & control*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D013903:Thoracic Surgery
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal