Abstract
Background: Thoracic epidural analgesia (TEA) after thoracic surgery provides the most effective analgesia, influences the neurohumoural stress response and cardiovascular pathophysiology.
Aim: To evaluate the impact of TEA, via a catheter placed pre-operatively, on extubation time and pain scores in patients undergoing mitral valve replacement surgery.
Methods: In this prospective, randomized study, eighty four patients scheduled for elective mitral valve replacement surgery were randomly allocated into two groups (42 patients each). Patients in the first group (TEA) subjected to combined general anesthesia and TEA while those in the second group (opioid based) received opioid-based general anesthesia. Extubation time was recorded, hemodynamic stability and pain scores were assessed up to 48 h after surgery. The total dose of fentanyl consumed over 48 hr postoperatively was recorded.
Results: There was a statistically significant decrease (P<0.001) in extubation time in TEA group compared with that in opioid based group. In addition, there was significantly lower mean pain scores (P<0.01) throughout the postoperative observational period in the TEA group compared with those in the opioid based group. The total dose of fentanyl consumed over 48 hours was higher in opioid based group than that of TEA group (P<0.001).
Conclusion: From surgical perspective, early extubation, amelioration of severity of postoperative pain and rapid regaining physical activity obtained via TEA improves the surgical outcome via reduction of postoperative complications, shortening of intensive care and hospital stay and saving financial resources.
Keywords: Early Extubation; Thoracic Epidural Anesthesia; Mitral Valve Surgery.