Epidural Anesthesia and Postoperative Analgesia With Ropivacaine and Fentanyl

Northern State Medical University93 enrolled

Overview

The aim of the present study was to assess the efficacy of thoracic epidural anesthesia followed by postoperative epidural infusion and patient-controlled epidural analgesia with ropivacaine/fentanyl in off-pump coronary artery bypass grafting

Ninety-three patients were scheduled for off-pump coronary artery bypass (OPCAB) under propofol/fentanyl anesthesia. Day before surgery patients were asked for informed consent and randomized into three postoperative analgesia regimens aiming at a visual analog scale (VAS) score \<30 mm at rest. The control group (n=31) received intravenous fentanyl 10 µg/ml postoperatively 3-8 mL/h. After placement of an epidural catheter at the level of Th2-Th4 before OPCAB, a thoracic epidural infusion (EI) group (n=31) received epidural anesthesia (EA) intraoperatively with ropivacaine 0.75% 1 mg/kg and fentanyl 1 µg/kg followed by continuous EI of ropivacaine 0.2% 3-8 mL/h and fentanyl 2 µg/mL postoperatively. The patient-controlled epidural analgesia (PCEA) group (n=31), in addition to EA and EI, received PCEA (ropivacaine/fentanyl bolus 1 mL, lock-out interval 12 min) postoperatively. Hemodynamics and blood gases were measured throughout 24 h after OPCAB.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Coronary Artery Disease

Interventions

intravenous analgesiaPROCEDURE

Patients received postoperative analgesia with intravenous infusion of fentanyl 10 µg/ml 3-8 mL/h

epidural infusionPROCEDURE

Postoperative analgesia was performed using continuous epidural infusion of ropivacaine 0.2% 3-8 mL/h and fentanyl 2 µg/mL

patient-controlled epidural analgesiaPROCEDURE

Postoperative analgesia was performed by continuous epidural infusion of ropivacaine/fentanyl mixture combined with patient-controlled epidural analgesia with ropivacaine/fentanyl bolus 1 mL, lock-out interval 12 min.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * presence of coronary artery disease * ASA II-III * elective off-pump coronary artery bypass Exclusion Criteria: * age \< 18 years * severe valve dysfunction or peripheral vascular disease * simultaneous interventions (carotid endarterectomy, aneurysm repair, etc.) * transfer to CPB during surgery

Locations (1)

Dep. of Anesthesiology, Northern SMU

Arkhangelsk, Russia

Outcomes

Primary Outcomes

Duration of postoperative mechanical ventilation

Duration of postoperative mechanical ventilation, hours

Time frame: Participants will be followed for the duration of mechanical ventilation, an expected average of 6 hours

Secondary Outcomes

Hemodynamic stability

Hemodynamic stability as assessed by mean arterial pressure, heart rate, cardiac index, requirement of inotrops/vasoactives and colloids

Time frame: All period of operation and during 24 hours postoperatively

Data from ClinicalTrials.gov

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