High Thoracic Epidural Analgesia as an Adjunct to General Anesthesia in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

To investigate the effect of high thoracic epidural analgesia combined with general anesthesia on pain management and postoperative outcomes in patients undergoing off-pump Coronary Artery Bypass Grafting (CABG).

Patients were divided into two groups; Group 1 received general anesthesia and high thoracic epidural anesthesia whereas Group 2 received general anesthesia alone during off-pump coronary artery bypass grafting. Epidural catheters were placed at least 6 hours before transfer to the operating room. An epidural analgesic solution of 0.25% bupivacaine and 10 µg/ml fentanyl was started as continuous infusion at 5 ml/hour and maintained for at least 12 hours after completion of surgery. A 10-cm visual analog scale was used to measure pain at 4^th, 6^th, 9^th and 12^th postoperative hours.

Mean time to extubation was similar between two groups (2.45±0.88 vs. 2.59±1.31 for Groups 1 and 2, respectively, p=0.90). In all measurements, mean Visual Analogue Scale VAS scores were significantly lower in Group 1 compared to Group 2 (6.50±1.53 vs. 4.09±1.83 at 4^th hour, 6.62±1.55 vs. 3.71±1.85 at 6^th hour, 5.83±1.40 vs. 2.93±1.54 at 9^th hour and 4.41±1.97 vs. 2.50±1.19 at 12^th hour, p<0.001 in each comparison).

Continuous high thoracic epidural analgesia seems to be a good adjunct to general anesthesia, as its pain relief effect becomes obvious at 4^th postoperative hour and lasts at least 12^th postoperative hour.