Impact of thoracic epidural analgesia and local anesthetic infiltration in providing postoperative analgesia in cardiac surgeries and benefits beyond analgesia.

Abstract

BACKGROUND: Pain is most severe in patients undergoing cardiac surgeries. Various methods for pain relief have been used for providing postoperative analgesia ranging from opioids, NSAIDS, nerve blocks, local infiltration and thoracic epidurals.
OBJECTIVES:
1. To compare the effectiveness of thoracic epidural anesthesia and local anesthetic infiltration in providing postoperative analgesia in patients undergoing elective cardiac surgeries.
2. To compare tube toleration and quality of extubation in the study groups.
STUDY DESIGN: Prospective observational study.
PARTICIPANTS: 52 patients undergoing cardiac surgeries.
METHODS: Patients were divided into two groups. 32 patients received local anesthetic infiltration and 20 patients received thoracic epidural. At extubation both groups were assessed for Ramsay sedation score, tube toleration and quality of extubation. After extubation patients were interrogated for pain by VAS at rest, deep breathing and coughing at 0, 4, 6,12,24,36 and 48 hours from extubation. In addition to VAS; heart rate, blood pressure, respiratory rate and saturation was also noted. In the event of pain; VAS greater than or equal to 4 rescue analgesia was given intravenously in both the groups. Time for first rescue analgesic was recorded for both groups and total consumption of rescue analgesia for the first 48 hours was also calculated.
RESULTS: Patients receiving thoracic epidural had lower VAS scores and lower rescue analgesia requirement. Endotracheal tube toleration and extubation quality was better in patients receiving epidural analgesia.
CONCLUSIONS: Thoracic epidurals provide superior analgesia than local anesthetic infiltration of the surgical site in cardiac surgeries.
IMPLICATIONS: Thoracic epidural analgesia seems to be a better choice for patients undergoing cardiac surgeries.