Does high thoracic epidural analgesia with levobupivacaine preserve myocardium? A prospective randomized study.
BACKGROUND
Our study aimed to compare HTEA and intravenous patient-controlled analgesia (PCA) in patients undergoing coronary bypass graft surgery (CABG), based on haemodynamic parameters and myocardial functions.


METHODS
The study included 34 patients that were scheduled for elective CABG, who were randomly divided into 2 groups. Anesthesia was induced and maintained with total intravenous anesthesia in both groups while intravenous PCA with morphine was administered in Group 1 and infusion of levobupivacaine was administered from the beginning of the anesthesia in Group 2 by thoracic epidural catheter. Blood samples were obtained presurgically, at 6 and 24 hours after surgery for troponin I, creatinine kinase-MB (CK-MB), total antioxidant capacity, and malondialdehyde. Postoperative pain was evaluated every 4 hours until 24 hours via VAS.


RESULTS
There were significant differences in troponin I or CK-MB values between the groups at postsurgery 6 h and 24 h. Heart rate and mean arterial pressure in Group 1 were significantly higher than in Group 2 at all measurements. Cardiac index in Group 2 was significantly higher than in Group 1 at all measurements.


CONCLUSIONS
Patients that underwent CABG and received HTEA had better myocardial function and perioperative haemodynamic parameters than those who did not receive HTEA.
Department of Anesthesiology and Reanimation, Turkiye Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey.
Serife Gokbulut
SG
Bektas
Yuksek Ihtisas Education and Research Hospital, kızılay sokak No. 4, Altındag , Sıhhıye, 06810 Ankara, Turkey.
Sema
0000-0003-2443-0390
S
Turan
Department of Anesthesiology and Reanimation, Turkiye Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey.
Umit
U
Karadeniz
Department of Anesthesiology and Reanimation, Turkiye Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey.
Burcin
B
Ozturk
Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey.
Soner
S
Yavas
Department of Biochemistry, Turkiye Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey.
Dilan
D
Biricik
Department of Biochemistry, Turkiye Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey.
Gul Sevim
GS
Saydam
Department of Anesthesiology and Reanimation, Turkiye Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey.
Ozcan
O
Erdemli
D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods*; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006348:Cardiac Surgical Procedures; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D000077554:Levobupivacaine; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D059408:Pain Management; D010149:Postoperative Pain / Q000188:drug therapy / Q000473:pathology
D009020:Morphine; D000077554:Levobupivacaine; D002045:Bupivacaine