title: A prospective randomized study of intraoperative thoracic epidural analgesia in off-pump coronary artery bypass surgery.
abstract: OBJECTIVE
  The purpose of this study was to test the hypothesis that general anesthesia (GA) plus thoracic epidural anesthesia (TEA) has no impact on the outcomes of off-pump coronary artery bypass surgery (OPCABs) compared to GA followed by patient-controlled TEA (PCTEA), while GA plus TEA leads to a higher requirement for vasoactive drug use.
  
  
  METHODS
  Sixty-four patients, American Society of Anesthesiologists physical status II and III, who were scheduled for elective OPCABs, were offered an epidural catheter inserted at the T2-3 interspace and then randomized into 1 of 2 groups according to whether TEA was applied intraoperatively. The TEA(perio) group received GA plus TEA, while the TEA(post) group received GA alone. All groups had postoperative PCTEA. The number of requirements for vasoactive drugs and the extubation times were recorded. The analgesic effect was monitored by visual analog scale (VAS) pain scores. Heart rate, blood pressure, and blood gases were also monitored. The data are presented as mean values ± standard deviation, or medians with quartiles.
  
  
  RESULTS
  The proportion of vasoactive drug use was significantly higher in the TEA(perio) group intraoperatively (before or during completion of anastomoses: 59.4 vs. 20.7%, p = 0.004; after completion of anastomoses: 53.1 vs. 17.2%, p = 0.007). There was no statistically significant difference in extubation times or VAS scores between the 2 groups.
  
  
  CONCLUSIONS
  We conclude that GA plus TEA has no impact on the outcomes of OPCABs, while its use leads to a higher requirement for vasoactive drug use. GA followed by PCTEA facilitates the anesthesia administration, while it does not affect the extubation time and the postoperative analgesic effect.
authors.affiliation: Department of Anesthesiology, The Affiliated Hospital of Qingdao University Medical College, Qingdao, People's Republic of China.
authors.forename: Yongxin
authors.initials: Y
authors.lastname: Liang
authors.forename: Haichen
authors.initials: H
authors.lastname: Chu
authors.forename: Hua
authors.initials: H
authors.lastname: Zhen
authors.forename: Shiduan
authors.initials: S
authors.lastname: Wang
authors.forename: Miaoning
authors.initials: M
authors.lastname: Gu
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural; D000768:Anesthesia, General; D047549:Coronary Artery Bypass, Off-Pump; D004569:Electroencephalography / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies