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首页> 外文期刊>Cardiovascular Journal >Comparison of Recovery and Postoperative Analgesia between Thoracic Epidural Anaesthesia (TEA) plus General Anaesthesia and General Anaesthesia alone, in Patients Undergoing Off-Pump Coronary Artery Bypass (OPCAB) Surgery
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Comparison of Recovery and Postoperative Analgesia between Thoracic Epidural Anaesthesia (TEA) plus General Anaesthesia and General Anaesthesia alone, in Patients Undergoing Off-Pump Coronary Artery Bypass (OPCAB) Surgery

机译：接受非体外循环冠状动脉搭桥手术（OPCAB）的患者的胸膜硬膜外麻醉（TEA）加全身麻醉和单纯全身麻醉之间的恢复和术后镇痛比较

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Background: In recent years, high thoracic anaesthesia (HTEA) combined with general anaesthesia has been extensively studied in patients undergoing coronary artery bypass graft surgery with or without cardiopulmonary bypass. Off-pump coronary artery bypass grafting was implemented to reduce trauma of surgical coronary revascularization by avoiding extracorporeal circulation. TEA in combination with GA further reduces intraoperative stress resulting in more rapid extubation and significantly better pain relief in patients undergoing off-pump coronary artery bypass grafting (OPCAB). In addition, common postoperative complications are also decreased. Methodology: 40 male patients aged between 40-65 years with CAD undergoing OPCAB surgery at NICVD from April 2006 to October 2008 were randomly divided in two groups. Group A received epidural analgesic drugs through an indwelling catheter introduced before induction of anesthesia while group B patients received standard general anesthesia (GA) alone. Group A patients received continuous epidural analgesia delivered through the indwelling catheter with a mixture of Lignocaine (2%) 20 ml + Bupivacaine (0.5%) 20 ml + Fentanyl 50 gm 1 ml + normal saline q.v. 50 ml at the rate of 1-2 ml/hour by a syringe pump for up to 72 hours. Group B patients received conventional intermittent narcotics (Morphine)/NSAIDS (Ketorolac/Diclofen) for up to 72 hours. Results: Haemodynamic parameters of all patients in both the groups were within acceptable range throughout operations. Incidence of cardiac dysrhythmias was less in patients of group A. Group A patients showed faster recovery and better analgesia compared to Group B patients. There was also decreased incidence of nausea, vomiting, arrhythmia, O2 desaturation, confusional states, renal failure and requirement of iontropic support in ICU in Group A patients. TEA for postoperative analgesia was safe and well accepted by the patients. There was no complication related to epidural anesthesia in any patient. Conclusion: TEA in general anesthesia provides faster recovery and effective analgesia. Nonetheless, the actual and potential risks of TEA during cardiac surgery should not be underestimated.
机译：背景：近年来，在接受或不接受体外循环的冠状动脉搭桥手术中，高胸腔麻醉（HTEA）联合全身麻醉已被广泛研究。实施非体外循环冠状动脉搭桥术可通过避免体外循环减少外科手术冠状动脉血运重建的创伤。 TEA与GA联合使用可进一步降低术中压力，从而使接受非体外循环冠状动脉搭桥术（OPCAB）的患者的拔管更加迅速，并且疼痛明显改善。此外，常见的术后并发症也有所减少。方法：将2006年4月至2008年10月在NICVD进行OPCAB手术的40例40-65岁的CAD男性患者随机分为两组。 A组通过在麻醉诱导前引入的留置导管接受硬膜外镇痛药，而B组患者仅接受标准全身麻醉（GA）。 A组患者接受通过留置导管连续输注硬膜外镇痛，其中使用的是Lignocaine（2％）20 ml +布比卡因（0.5％）20 ml +芬太尼50 gm 1 ml +生理盐水q.v。通过注射泵以1-2毫升/小时的速度注入50毫升，长达72个小时。 B组患者接受常规间歇性麻醉剂（吗啡）/ NSAIDS（酮咯酸/双氯芬）长达72小时。结果：两组患者在整个手术过程中的血流动力学参数均在可接受范围内。 A组患者的心律不齐的发生率较低。与B组患者相比，A组患者恢复更快且镇痛效果更好。 A组患者ICU中恶心，呕吐，心律不齐，O2饱和度降低，意识模糊，肾功能衰竭和需要离子支持的发生率也有所降低。术后镇痛用TEA是安全的，并为患者所接受。在任何患者中都没有与硬膜外麻醉有关的并发症。结论：TEA全身麻醉可提供更快的恢复和有效的镇痛作用。尽管如此，不应低估心脏手术期间TEA的实际和潜在风险。

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