title: [Effects of prolonged thoracic epidural analgesia on the frequency of postoperative atrial fibrillation in thoracic surgery].
abstract: Postoperative atrial fibrillation (POAF) has remained one of the most common complications that occur following non-cardiac thoracic surgery. Although it is dificult to determine the true incidence ofPOAF due to various methodologies used to identify its occurrence, reported rates have varied between 12 and 67%. The occurrence of POAF is associated with significant morbidity, such as increased risk ofstroke, atrial thrombosis and systemic mbolism, postoperative mortality, and significant increases in hospital length of stay and costs.
  
  
  OBJECTIVE
  We aimed to evahluate the impact of thoracic epidural analgesia on the frequency of POAF in patients undergone lung cancer surgery.
  
  
  METHODS
  We performed a retrospective analysis of medical cards of472 patients over 55 y.o., undeigone luhmg surgery (lobectomy (LE) and pneumonectomy (PE)) due to oncological diseases. The patients' physical status was II-Ill according to ASA classification. The average duration of the operations was 204.3±59.4 min. The average blood loss was 393±198 ml. The patients were divided into two groups according to the type of anaesthesia during the surgery and type of pain management during postoperative period Each group was divided into subgroups according to the type ofsurgery (LE and P4E). The patients of the group-1 (N=300, average age 61.7±7.74years) received a general anaesthesia (GA) (fentanyl, ketamine, propofol, sevoflurane) with intercostal blockade with mixture of alcohol and nodvocain in the end ofsumgery and follow ing complex analgesia in postoperative period (opioid analgesics, NSAIDs). The patients of the group-2 (N= 172, average age 62.2±7.45 years) received a combined (CA) general anaesthesia (propofol, ketamine. fentanyl, sevoflurane) and thoracic epidural analgesia with ropivacaine 0.3%, fenianyl 4 µg/ml and epinephrine 2 µg/ ml. These patients received the epidural infusion of ropivacaine 0.2%, fentanyl 2 µg/mnl and epinephrine 2 µg/ml for 5-7 days after the surgery. In postoperative period all patients in both groups received standard systemic analgesia with opioid analgesics. NSAIDs, paracetamol. A fixation of POAF wias heldfrom the first day after the surgery and until a discharge according to clinical signs and ECG fJacts.
  
  
  RESULTS
  In GA-group the frequency ofPOAF was 15.3% (46/300). The overall incidence of POAF did not differ between patients undergone pneumonectomy and lobectomy in GA (21.6% (16/74) vs. 13.7% (30/226), respectively (p=0.08)). In CA-group the frequency of POAF was significantly reduced versus GA-group (8.7% (15/172) vs. 15.3% (46/300), respectively (p=0.04)). Patients mundergone pneumonectomy suffered from postoperative atrial fibrillation in 13.2% (9/68) of cases and lobectomy in 62% (6/104) of cases in CA (p=0.09). The frequency of POAF in patients undergone pneumonectomy did not differ significantly between the groups (p=0.19), but the frequency of postoperative atrial fibrillation in patients undergone lobectomy was significantly reduced in CA versus GA (p=0.04).
  
  
  CONCLUSIONS
  Postoperative thoracic epidural analgesia significantly decreases the frequency of postoperative atrial fibrillation in patients undergoing extended lungs surgery and most effective in patients undergoing lobectomy.
authors.forename: A A
authors.initials: AA
authors.lastname: Aleksin
authors.forename: V É
authors.initials: VÉ
authors.lastname: Khoronenko
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods*; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D004562:Electrocardiography; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000700:Analgesics