title: Nonanalgesic benefits of combined thoracic epidural analgesia with general anesthesia in high risk elderly off pump coronary artery bypass patients.
abstract: OBJECTIVE
  Epidural anesthesia is a central neuraxial block technique with many applications. It is a versatile anesthetic technique, with applications in surgery, obstetrics and pain control. Its versatility means it can be used as an anesthetic, as an analgesic adjuvant to general anesthesia, and for postoperative analgesia. Off pump coronary artery bypass (OPCAB) surgery triggers a systemic stress response as seen in coronary artery bypass grafting (CABG). Thoracic epidural anesthesia (TEA), combined with general anesthesia (GA) attenuates the stress response to CABG. There is Reduction in levels of Plasma epinephrine, Cortisol and catecholamine surge, tumor necrosis factor-Alpha( TNF ά), interleukin-6 and leucocyte count.
  
  
  METHODS
  A prospective randomised non blind study.
  
  
  METHODS
  A clinical study in a multi specialty hospital.
  
  
  METHODS
  Eighty six patients. Material and Methods/intervention: The study was approved by hospital research ethics committee and written informed consent was obtained from all patients. Patients were randomised to receive either GA plus epidural (study group) or GA only (control group). Inclusion Criteria (for participants) were -Age ≥ 70 years, Patient posted for OPCAB surgery, and patient with comorbidities (diabetes mellitus, chronic obstructive pulmonary disease, cerebrovascular disease, peripheral vascular disease, renal dysfunction). Serum concentration of Interlukin: - 6, TNF ά, cortisol, Troponin - I, CK-MB, and HsCRP (highly sensitive C reactive protein), was compared for both the group and venous blood samples were collected and compared just after induction, at day 2, and day 5 postoperatively. Time to mobilization, extubation, total intensive care unit stay and hospital stay were noted and compared. Independent t test was used for statistical analysis.
  
  
  METHODS
  Postoperative complications, total intensive care unit stay and hospital stay. Secondary Outcome: Stress response.
  
  
  RESULTS
  Study group showed decreased Interlukin - 6 at day 2, TNF ά at day 2 and 5,troponin I at day 5, and decreased total hospital stay ( p < 0.05).
  
  
  CONCLUSIONS
  Thoracic epidural anesthesia decreases stress and inflammatory response to surgery and decreases hospital stay. However a large multicentre study may be needed to confirm it.
authors.forename: Bhanu Prakash
authors.initials: BP
authors.lastname: Zawar
authors.affiliation: Institute of Critical Care Anesthesiology, Medanta The Medicity, Gurgaon, Haryana, India.
authors.forename: Yatin
authors.initials: Y
authors.lastname: Mehta
authors.forename: Rajiv
authors.initials: R
authors.lastname: Juneja
authors.forename: Dheeraj
authors.initials: D
authors.lastname: Arora
authors.forename: Arun
authors.initials: A
authors.lastname: Raizada
authors.forename: Naresh
authors.initials: N
authors.lastname: Trehan
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural; D000768:Anesthesia, General; D002395:Catecholamines / Q000097:blood; D047549:Coronary Artery Bypass, Off-Pump; D004837:Epinephrine / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007902:Length of Stay / Q000706:statistics & numerical data; D007962:Leukocytes; D008297:Male; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control*; D011446:Prospective Studies; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D002395:Catecholamines; C508600:IL6 protein, human; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D006854:Hydrocortisone; D004837:Epinephrine