What question did this study set out to answer?

This research aims to evaluate the protective effects of epidural anesthesia combined with general anesthesia during cardiac surgery.

February 5, 2026Open Access

Epidural Anesthesia as a Protective Factor in Cardiac Surgery: A Prospective Randomized Study

Key Points

This research aims to evaluate the protective effects of epidural anesthesia combined with general anesthesia during cardiac surgery.
Prospective randomized controlled trial design.
Sixty male patients undergoing elective off‐pump coronary artery bypass grafting were randomized into two groups: general anesthesia alone or general anesthesia plus epidural anesthesia.
Epidural anesthesia was administered at the T2–T3 level with continuous bupivacaine infusion.
The GA + EA group had shorter mechanical ventilation duration (4.59 vs. 5.72 hours).
Hospital stays were reduced (5.43 vs. 6.73 days) in the GA + EA group.
Higher internal mammary artery blood flow was noted in the GA + EA group.
Plasma aldosterone levels were lower in the GA + EA group, indicating reduced stress (left artery: 13.38 vs. 17.68 ng/dL).
Long-term outcomes showed superior major adverse cardiovascular event-free survival in the GA + EA group.

Abstract

Background Epidural anesthesia (EA) has gained prominence in rapid postoperative recovery protocols for cardiac surgery, aiming to reduce opioid use, shorten intensive care stays, and improve patient outcomes. This prospective randomized controlled trial evaluated the protective effects of EA combined with general anesthesia (GA + EA) compared to GA alone in patients undergoing off‐pump coronary artery bypass grafting (CABG). Methods Sixty male patients undergoing elective off‐pump CABG were randomized into two groups: GA ( n = 30) and GA + EA ( n = 30). Surgical procedures were standardized using bilateral internal mammary arteries skeletonized with an ultrasonic scalpel. Patients in the GA + EA group received thoracic EA at the T2–T3 level, confirmed radiologically, with continuous bupivacaine infusion. Results Significant benefits were observed in the GA + EA group, including shorter mechanical ventilation duration (4.59 vs. 5.72 h; p = 0.011) and reduced hospital stay (5.43 vs. 6.73 days; p = 0.001). Internal mammary artery blood flow measurements were significantly higher in the GA + EA group ( p < 0.001). Plasma aldosterone levels were significantly lower in GA + EA patients, indicating reduced stress‐induced hormonal responses (left artery: 13.38 vs. 17.68 ng/dL, p = 0.005; right artery: 12.77 vs. 18.37 ng/dL, p = 0.003). Long‐term outcomes demonstrated superior major adverse cardiovascular event (MACE)‐free survival in the GA + EA group ( p < 0.001). Cox regression analysis confirmed that GA + EA independently reduced cardiovascular risk, even after adjusting for age, ejection fraction, and dopamine levels (HR = 0.0118, p < 0.001). Higher aldosterone levels significantly correlated with increased MACE risk ( p < 0.05). Conclusions The study highlights aldosterone suppression as a potential mechanism underlying EA’s cardioprotective effects, emphasizing its role in enhancing recovery and reducing cardiovascular complications. Despite limitations such as small sample size and single‐center design, findings strongly support integrating EA into cardiac surgical practice.

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