Treatment of Refractory Angina Pectoris with High Thoracic Epidural Analgesia / 대한마취과학회지

ABSTRACT

A 64-year-old woman presented with severe chest pain and indigestion for ten days. She had been repeatedly admitted for the same symptoms, and had been treated with oral medication with no improvement. Coronary angiography revealed total occlusion of the left anterior descending and circumflex arteries. The patient was referred to our department because the other medical treatments had been unsuccessful and neither angioplasty nor coronary artery bypass surgery was safe. An epidural catheter was placed at the T2-3 level and a 5 mL bolus of 0.25% bupivacaine completely relieved the patient's angina. The arterial blood pressure and heart rate remained unchanged and the IV nitrates were discontinued. An infusion of 100 mL 0.0625% bupivacaine with 10 mg morphine was started at 4 mL/h. During the following 13 days, the patient remained pain free with 5 mL of 0.25% bupivacaine. Her symptoms continued to diminish and she remained free of pain even after discontinuing the high thoracic epidural anesthesia (HTEA), but she still took an occasional oral dose of nitrates.