Effect of thoracic epidural analgesia on refractory angina pectoris: long-term home self-treatment

To evaluate the effects of long-term home self-treatment with thoracic epidural analgesia (TEA) on angina, quality of life, and safety.

Prospective consecutive pilot study.

Department of Cardiology, Heart Center, Linköping University Hospital.

Between January 1998 and January 2000, 37 consecutive patients with refractory angina began treatment with TEA, using a subcutaneously tunnelled epidural catheter.

The 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.

All 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.

Long-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.