Epidural anesthesia and analgesia: effects on recovery from cardiac surgery

Abstract

Objective: To measure predefined clinical effects resulting from the use of epidural anesthesia and analgesia during and after cardiac surgery.

Design: Prospective, randomized, nonblinded clinical trial.

Setting: Single academic medical center.

Participants: Sixty patients scheduled for elective cardiac surgery with cardiopulmonary bypass.

Interventions: Sixty participants were randomly assigned to 1 of 2 study groups: (1) A control group received general anesthesia during surgery and intravenous opiate analgesia after surgery. (2) A treatment group received thoracic epidural anesthesia combined with general anesthesia during surgery and epidural analgesia for the first 24 postoperative hours.

Measurements and main results: Primary study measurements were planned to evaluate recovery from surgery and included time to tracheal extubation, duration of postoperative intensive care unit stay, duration of postoperative hospitalization, pain control, urinary free cortisol, cardiopulmonary complication rate, and total hospital charges. No statistically significant differences between the 2 study groups were found in these main measurements.

Conclusions: The clinical course of elective cardiac surgical patients who receive epidural anesthesia during surgery and epidural analgesia after surgery is comparable to that of patients managed with general anesthesia alone during surgery followed by parenteral opiate analgesia after surgery.