Epidural analgesia for total hip replacement in a patient with dilated cardiomyopathy

A 69-year-old patient with severe impairment of left ventricular function secondary to dilated cardiomyopathy underwent a successful total hip replacement under epidural analgesia. Perioperative heart rate and mean arterial pressure were stable at an analgesic level up to the seventh thoracic dermatome, achieved with mepivacaine two per cent with epinephrine. Asymptomatic pulmonary hypertension, occurring during the insertion of the femoral prosthesis, subsided spontaneously over the next twelve hours. The circulatory effects of epidural analgesia and their significance in a patient with dilated cardiomyopathy are discussed.