ABSTRACT

This prospective, randomized study was designed to evaluate the impact of thoracic epidural analgesia (TEA), via a catheter sited pre


Eighty consecutive patients were scheduled for elective valve surgery was randomly allocated into two equal groups (40 patients each), group TEA: subjected to combined general anesthesia and thoracic epidural analgesia. Group Control: subjected to Opioid-based general anesthesia. TEA group received bolus dose of 8-12 ml of Ropivacaine 0.5% with 50-100 µg Fentanyl via the epidural catheter one hour before induction of the general anesthesia. General anesthesia was induced in TEA group with Fentanyl (2µg/kg) plus thiopentone (5mg/kg) followed by propofol infusion at 5mg/kg/hour and pancuronium 0.1mg/kg was used for muscle relaxation. Group Control was induced with Fentanyl (15µg/kg) plus thiopentone (5mg/kg) followed by propofol infusion at 5mg/kg/hour and pancuronium 0.1mg/kg. The extubation time was recorded in the two groups. Hemodynamic stability and pain scores were assessed up to 48 hour after surgery.

There was a highly statistically significant (P = 0.000) decrease in extubation time in TEA group compared with Opioid group. In addition, there was significantly lower in mean pain scores throughout the postoperative observational period in the TEA group compared with Control group, also the total dose of fentanyl consumed over 48 hr was higher in Control group than that of TEA group. CVP, and heart rate were lower in TEA group than that of Control group but this were not statistically significant.

The routine use of TEA, when certain safety measures are taken, is feasible and helpful in cardiac valve surgery.