Original article: cardiovascularProspective randomized trial of high thoracic epidural analgesia for coronary artery bypass surgery
Section snippets
Material and methods
Institutional ethics committee approval and informed written consent were obtained. A single surgeon performed all operations, completed between 1998 and 2001. Eighty patients undergoing elective CABG were randomized to receive high thoracic epidural analgesia (HTEA) or a patient controlled intravenous morphine analgesic (control). Acetaminophen, indomethacin, and tramadol were allowed as supplemental analgesia in both groups.
Results
Eighty patients were randomized, and 3 patients from the HTEA group were withdrawn (1 patient withdrew themself from the study after randomization, deciding not to participate in research, and 2 patients failed epidurals prior to induction), and 1 patient from the control group withdrew from the study after randomization and requested the epidural instead. Hence, analysis was performed on 37 HTEA and 39 control patients. There were no differences in demographic variables or the number of grafts
Primary endpoint
The primary reason for using an epidural analgesic technique is to provide optimal pain relief. Our study found a significant reduction in the pain experienced after coronary surgery (Table 3).
Sixty-three percent of the HTEA patients experienced no pain or only mild pain at all times postoperatively. Conversely, the pain experienced by patients who received intravenous opioid infusions (with supplementary agents) was far more varied. Their pain ranged from mild to severe, and more so when
Acknowledgements
We thank Karen Groves, Dr Michael Barrington, the Department of Biomedical Engineering, Royal Melbourne Hospital for technical support, and the cardiothoracic and operating suite nursing staff for their support. Prof John Ludbrook performed the statistical analysis (Biomedical Statistical Consulting Pty, Ltd). We thank Prof John Ludbrook and Prof James Angus for manuscript review. The study is supported by grants from the National Heart Foundation of Australia; Australian Society of
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