• Burak Onan, Ismihan Selen Onan, Levent Kilickan, and Ilhan Sanisoglu.
• Department of Cardiovascular Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Turkey. burakonan@hotmail.com
• J Card Surg. 2013 May 1;28(3):248-53.

ObjectiveTo evaluate the effects of thoracic epidural anesthesia (TEA) as an adjunct to general anesthesia (GA) on postoperative pain after coronary artery bypass grafting (CABG).MethodsBetween April 2009 and March 2010, 40 patients with ischemic heart disease scheduled for elective CABG were prospectively randomized to receive either GA (n = 20) or GA + TEA (n = 20). Through epidural catheters, patients received an infusion of (10-20 mg/h) 0.25%-bupivacaine intraoperatively and during the first 24 hours after surgery. Study endpoints included assessment of postoperative pain at rest and with coughing, rescue analgesic need, and postoperative course.ResultsThe differences in pain scores were decreased at rest during 6 (0.1 ± 0.3 vs. 2.4 ± 1.8; p < 0.05) and 12 hours (0.1 ± 0.3 vs. 3.9 ± 2.3; p < 0.05) and with coughing at 6 (0.1 ± 0.3 vs. 5.6 ± 2.2; p < 0.05), 12 (0.1 ± 0.3 vs. 5.9 ± 2.3; p < 0.05), and 24 hours (0.05 ± 0.2 vs. 4.6 ± 2.9; p < 0.05) in the GA + TEA group. At one-month follow-up, pain scores were decreased in GA + TEA group (0.3 ± 0.7 vs. 1.6 ± 1.3; p = 003). There was no significant difference at three and six months. Mechanical ventilation time (4.7 ± 1.2 vs. 2.9 ± 1.1 hours; p < 0.05), intensive care unit stay (28.4 ± 9.0 vs. 22.4 ± 3.4 hours; p < 0.05), and hospital stay (7.2 ± 1.1 vs. 6.1 ± 0.3 days; p = 0.001) were reduced in the GA + TEA group.ConclusionsTEA significantly reduced the intensity of postoperative pain and analgesic consumption in the early postoperative period following CABG. The delivery of effective analgesia along with conventional medications may prevent chronic pain after surgery.© 2013 Wiley Periodicals, Inc.

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