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March 1, 1995Regional Anesthesia The Journal of Neural Blockade in Obstetrics Surgery & Pain Control

Postoperative Myocardial Ischemia: Epidural versus Intravenous Patient-controlled Analgesia: A Pilot Project

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Why the study?

Does continuous epidural analgesia with bupivacaine and morphine reduce postoperative myocardial ischemia and infarction compared to intravenous patient-controlled analgesia in high-risk patients undergoing upper abdominal surgery?

Population

198 patients with two or more risk factors for coronary artery disease who were admitted to the ICU after…

Comparison

Continuous epidural anesthesia by injection at… vs General anesthesia followed by intravenous…

Design

Cohort, nonrandomized

Follow-up

5-7 days

Authors

DOde Leon-Casasola OaRoswell Park Comprehensive Cancer CenterLMLema MjThe Ohio State UniversityDKD KarabellaRoswell Park Comprehensive Cancer Center

Discussion

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Implication

May support epidural use to lower postoperative ischemia in high-risk surgery; leaves open causal benefit pending randomized confirmation.

Structured PICO

Does continuous epidural analgesia with bupivacaine and morphine reduce postoperative myocardial ischemia and infarction compared to intravenous patient-controlled analgesia in high-risk patients undergoing upper abdominal surgery?

P
Population
198 patients with two or more risk factors for coronary artery disease (CAD) who were admitted to the ICU after upper abdominal surgery for cancer.
I
Intervention
Continuous epidural anesthesia by injection at the T7-9 interspaces with 0.5% bupivacaine/0.013% morphine and light general anesthesia followed by 0.1% bupivacaine/0.01% morphine epidural analgesia for 5-7 days (n=110).
C
Comparator
General anesthesia (balanced technique) followed by intravenous patient-controlled analgesia with 0.1% morphine for 5-7 days (n=88).
O
Outcome
Incidence of postoperative myocardial ischemia and infarction.hard clinical

Continuous epidural analgesia may decrease the incidence of postoperative tachycardia, myocardial ischemia, and infarction in high-risk patients undergoing upper abdominal surgery compared to intravenous patient-controlled analgesia.

Cite This Study

Oa et al. (1995) studied this question.

synapsesocial.com/papers/6a89227c7c664faad1126b7dhttps://doi.org/10.1136/rapm-00115550-199520020-00005

Topics

Women and heart disease
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Reinfarction Following Anesthesia in Patients with Myocardial Infarction1983 · 627 citations
  2. 2Reevaluation of Perioperative Myocardial Infarction in Patients With Prior Myocardial Infarction Undergoing Noncardiac Operations1990 · 105 citations
  3. 3Thoracic Epidural Anesthesia Improves Global and Regional Left Ventricular Function During Stress-Induced Myocardial Ischemia in Patients With Coronary Artery Disease1990 · 182 citations
  4. 4Intensive Analgesia Reduces Postoperative Myocardial Ischemia? I1992 · 8 citations
  5. 5Myocardial infarction in patients undergoing noncardiac surgery1987 · 35 citations