title: Comparison of Perioperative Thoracic Epidural Fentanyl with Bupivacaine and Intravenous Fentanyl for Analgesia in Patients Undergoing Coronary Artery Bypass Grafting Surgery.
abstract: BACKGROUND
  Two-thirds of patients undergoing coronary artery bypass grafting (CABG) surgery report moderate to severe pain, particularly with ambulatory or respiratory effort.
  
  
  OBJECTIVE
  The aim of this study is to compare the analgesic effect of perioperative thoracic epidural fentanyl with bupivacaine and intravenous fentanyl in patients undergoing CABG surgery.
  
  
  METHODS
  The study was a prospective, randomized, nonblinded comparative study.
  
  
  METHODS
  A total of 60 patients coming under the American Society of Anesthesiologists Class III who were posted for CABG surgery were recruited in this study. The patients were randomized into one of two groups, higher thoracic epidural analgesia (HTEA) group receiving general anesthesia with thoracic epidural analgesia (TEA) in the postoperative period, and intravenous fentanyl analgesia group receiving general anesthesia with fentanyl infusion in the postoperative period. The pain was assessed at 4 h after extubation when the patient was fully awake, then at 8, 12, 18, and 24 h. Both groups received intravenous tramadol 100 mg as rescue analgesia whenever visual analog scale score was 5 and above. Heart rate, mean arterial pressure (MAP), sedation scores, and physiotherapy cooperation were also assessed.
  
  
  METHODS
  The numerical data were analyzed using an independentt-test, repeated-measures ANOVA, and Mann-Whitney U-test.
  
  
  RESULTS
  Pain at rest and on cough was significantly lower in HTEA patients as compared to control group. Patients HTEA group got less frequent rescue analgesia than the control group. Physiotherapy cooperation was significantly better in HTEA patients at 4, 12, and 24 h postextubation. They also had significantly lower heart rate, MAP, and sedation scores.
  
  
  CONCLUSIONS
  Perioperative TEA using fentanyl with bupivacaine provided optimal postoperative analgesia at rest and during coughing in patients following CABG surgery as compared to postoperative analgesia with intravenous fentanyl. It also resulted in optimal postoperative hemodynamic status, good cooperation to chest physiotherapy with less sedation.
authors.affiliation: Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
authors.forename: Amitabh Chanchal
authors.initials: AC
authors.lastname: Sen
authors.affiliation: Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
authors.forename: Sunil
authors.initials: S
authors.lastname: Rajan
authors.affiliation: Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
authors.forename: Rakhi
authors.initials: R
authors.lastname: Balachandran
authors.affiliation: Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Kumar
authors.affiliation: Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
authors.forename: Suresh Gangadharan
authors.initials: SG
authors.lastname: Nair
keywords: Analgesia; coronary artery bypass graft; fentanyl; intravenous; thoracic epidural