• Arina Richter, Ingemar Cederholm, Lena Jonasson, Carlo Mucchiano, Michael Uchto, and Birgitta Janerot-Sjöberg.
• Department of Cardiology, Heart Center, University Hospital, Linköping, Sweden. arina.richter@lio.se
• J. Cardiothorac. Vasc. Anesth. 2002 Dec 1; 16 (6): 679-84.

ObjectivesTo evaluate the effects of long-term home self-treatment with thoracic epidural analgesia (TEA) on angina, quality of life, and safety.DesignProspective consecutive pilot study.SettingDepartment of Cardiology, Heart Center, Linköping University Hospital.ParticipantsBetween January 1998 and January 2000, 37 consecutive patients with refractory angina began treatment with TEA, using a subcutaneously tunnelled epidural catheter.InterventionsThe patients were trained to provide self-treatment at home with intermittent injections of bupivacaine. Data were collected until January 2001, and the follow-up for each patient was 1 to 3 years.Measurements And Main ResultsAll but 1 of the patients improved symptomatically. The improvement was maintained throughout the treatment period (4 days to 3 years). The Canadian Cardiovascular Society angina class decreased from 3.6 to 1.7, frequency of anginal attacks decreased from 46 to 7 a week, nitroglycerin intake decreased from 32 to 5 a week, and the overall self-rated quality of life assessed by visual analog scale increased from 24 to 76 (all p < 0.001). No serious catheter-related complications occurred; however, 51% of the catheters became displaced and a new one had to be inserted during the study.ConclusionLong-term self-administered home treatment with TEA seems to be an effective and safe adjuvant treatment for patients with refractory angina. It produces symptomatic relief of angina and improves the quality of life.Copyright 2002, Elsevier Science (USA). All rights reserved.

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