High thoracic epidural analgesia improves postoperative cardiac outcome in ischemic patients undergoing major abdominal surgery

ABSTRACT

Postoperative cardiac morbidity and mortality continue to pose considerable risks to surgical patients. High thoracic epidural analgesia [HTEA], owing to its selective blockade of cardiac sympathetic innervation, has been used for treatment of medically or surgically refractory angina pectoris. However; its use in patients with coronary artery disease [CAD] undergoing non cardiac surgery has not been adequately investigated. The aim was to investigate the effect of HTEA on postoperative cardiac morbidity in patients with symptomatic CAD undergoing major abdominal surgery as opposed to a technique with comparable analgesic effect namely Low thoracic epidural analgesia [LTEA]. After approval, thirty patients with symptomatic CAD undergoing major abdominal surgery were included. Before general anesthesia, they were randomly allocated to have HTEA or LTEA for both intra and postoperative pain relief. In addition to haemodynamic measurements, postoperative cardiac morbidity was investigated by comparing the preoperative ECG, echocardiography and troponin I with the postoperative ones done one the first, third and seventh days. Data were expressed as mean [SE]. Cardiac morbidity was only diagnosed in 13.3% of patients in the HTEA group. In the LTEA group, 53.3% were found to have new ischemic changes and 13.3% developed postoperative MI. No cardiac mortality was reported in either group. Absolute risk reduction was 53.3% and the number needed to treat was found to be 2. HTEA in patients with CAD undergoing non-cardiac surgery has resulted in a reduced postoperative cardiac morbidity. It may be worthwhile establishing this technique, unless contra indicated, in such patients