Key result
Adding epidural to general anesthesia is linked to ~56% lower incidence of chronic post-thoracotomic pain.
Why the study?
No consensus had been established on the role of epidural anesthesia in preventing chronic post-thoracotomic pain during minimally invasive coronary bypass surgery.
Does epidural anesthesia reduce the incidence of chronic post-thoracotomic pain syndrome in patients undergoing MIDCAB surgery?
Cohort (n=87)
Yes
Does epidural anesthesia reduce the incidence of chronic post-thoracotomic pain syndrome in patients undergoing MIDCAB surgery?
The addition of epidural anesthesia to general anesthesia significantly reduces the incidence and resting severity of chronic post-thoracotomic pain up to 6 months after MIDCAB surgery.
May reduce chronic post-thoracotomic pain after MIDCAB; leaves open need for randomized confirmation before practice change.
BACKGROUND: No consensus has been established on the role of epidural anesthesia in relation to the prevention of chronic post-thoracotomic pain during minimally invasive coronary bypass surgery. OBJECTIVE: This study aimed to evaluate the effect of epidural anesthesia on the incidence of chronic post-thoracotomic pain syndrome after minimally invasive direct coronary artery bypass (MIDCAB) surgery. MATERIALS AND METHODS: The study included 87 patients who underwent MIDCAB surgery. In group 1, epidural anesthesia was performed before the induction of general anesthesia; in group 2, the operation was performed only under general anesthesia. RESULTS: The use of fentanyl for anesthesia varied: 0.5 (0.5; 0.6) mg in group 1 versus 3.5 (3.3; 3.6) mg in group 2 (p 0.01). The incidence of chronic post-thoracotomic pain in patients 3 months after surgery was higher in group 2 than in group 1 (39.1% vs 17.2%, p=0.005). The severity of pain at rest was 3 points (2; 3) in group 1 and 3 points (3; 3.5) in group 2 (p=0.018); however, during a deep breath, these differences became insignificant: 4 points (4; 4) in group 1 and 4 (4; 5) points in group 2 (p=0.453). At 6 months after surgery, chronic post-thoracotomic pain was present in 15.6% of the patients in group 1 and 34.8% in group 2 (p=0.011). After 6 months, the severity of pain at rest was 2.5 (2; 3) in group 1 and 3 (3; 3.75) in group 2 (p=0.01). No differences in cough were found: 4 (3.75; 4) points in group 1 and 4 (4; 4.5) points in group 2 (p 0.05). CONCLUSION: The use of epidural anesthesia led to a decrease in the incidence of chronic post-thoracotomic pain in patients undergoing MIDCAB surgery.
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Stukalov et al. (2022) conducted a cohort in Minimally invasive direct coronary artery bypass (MIDCAB) (n=87). Epidural anesthesia combined with general anesthesia vs. General anesthesia alone was evaluated on Incidence of chronic post-thoracotomic pain syndrome at 3 months (p=0.005). Epidural anesthesia combined with general anesthesia reduced the incidence of chronic post-thoracotomic pain syndrome at 3 months to 17.2% compared to 39.1% with general anesthesia alone.
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