Does high thoracic epidural analgesia with levobupivacaine preserve myocardium? A prospective randomized study

Biomed Res Int. 2015:2015:658678. doi: 10.1155/2015/658678. Epub 2015 Mar 31.

Abstract

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.

Materials and 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.

Conclusion: Patients that underwent CABG and received HTEA had better myocardial function and perioperative haemodynamic parameters than those who did not receive HTEA.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Analgesia, Epidural / methods*
  • Anesthesia, General / methods*
  • Bupivacaine / administration & dosage
  • Bupivacaine / analogs & derivatives*
  • Cardiac Surgical Procedures*
  • Coronary Artery Bypass / methods*
  • Female
  • Hemodynamics / drug effects
  • Humans
  • Levobupivacaine
  • Male
  • Middle Aged
  • Morphine / administration & dosage
  • Pain Management
  • Pain, Postoperative / drug therapy
  • Pain, Postoperative / pathology

Substances

  • Morphine
  • Levobupivacaine
  • Bupivacaine