Does high thoracic epidural analgesia with levobupivacaine preserve myocardium? A prospective randomized study

Area of Science:

• Anesthesiology
• Cardiovascular Surgery
• Critical Care Medicine

Background:

• Coronary artery bypass graft (CABG) surgery presents significant perioperative risks.
• Optimizing hemodynamic parameters and myocardial protection is crucial for patient outcomes.
• Current analgesic strategies require comparison for enhanced perioperative care.

Purpose of the Study:

• To compare thoracic epidural anesthesia (TEA) with intravenous patient-controlled analgesia (PCA) in CABG patients.
• To evaluate the impact of TEA on hemodynamic parameters and myocardial function.
• To assess biochemical markers of myocardial injury and oxidative stress.

Main Methods:

• 34 patients undergoing elective CABG were randomized into two groups.
• Group 1 received intravenous PCA with morphine; Group 2 received thoracic epidural anesthesia with levobupivacaine.
• Blood samples (troponin I, CK-MB, TAC, MDA) and visual analog scale (VAS) pain scores were collected.

Main Results:

• Group 2 (TEA) demonstrated significantly better myocardial function markers (troponin I, CK-MB) post-surgery.
• Heart rate and mean arterial pressure were significantly lower in the TEA group.
• Cardiac index was significantly higher in the TEA group compared to the PCA group.

Conclusions:

• Thoracic epidural anesthesia (TEA) provides superior perioperative hemodynamic control in CABG patients.
• TEA is associated with improved myocardial protection, indicated by reduced cardiac biomarkers.
• TEA represents a beneficial analgesic and anesthetic strategy for CABG surgery.