Document Detail


Thoracic epidural analgesia with levobupivacaine for 6 postoperative days attenuates sympathetic activation after thoracic surgery.
MedLine Citation:
PMID:  20947382     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVE: To investigate the impact of 2 postoperative analgesic regimens on heart rate variability in patients who underwent thoracotomy.
DESIGN: A prospective, randomized trial.
SETTING: A single-institutional study in a university hospital.
PARTICIPANTS: Fifty patients who underwent thoracotomy under combined general anesthesia and thoracic epidural analgesia divided by a number generator into 2 equal groups (A and B).
INTERVENTIONS: In group A, postoperative analgesia consisted of thoracic epidural analgesia with levobupivacaine for 6 postoperative days. In group B, on the 3rd postoperative day this regimen was changed to patient-controlled intravenous morphine. Heart rate variability recordings were performed on the day before surgery, after the epidural, after operation, and on every postoperative day. Statistical analysis used chi-square and Student t tests (Bonferroni correction).
MEASUREMENTS AND MAIN RESULTS: In both groups, the low-frequency component of the analyzed recordings declined after epidural and after surgery. In group A, the low-frequency component was significantly lower compared with baseline from the 2nd postoperative day onward, whereas in group B it was significantly higher compared with A on the 4th and 6th postoperative days. In both groups, the changes in high frequency were statistically insignificant. Intergroup comparisons of the low-/high-frequency ratio showed statistical difference on the last day of observation. There was no difference between the groups in hemodynamic variables and visual analog scale/10 scores.
CONCLUSIONS: Postoperatively decreased cardiac sympathetic outflow continues with epidural analgesia, whereas it is abolished by the change to intravenous patient-controlled morphine.
Authors:
Marina Simeoforidou; George Vretzakis; Metaxia Bareka; Eleni Chantzi; Andreas Flossos; Athanasios Giannoukas; Nikolaos Tsilimingas
Publication Detail:
Type:  Journal Article     Date:  2010-10-13
Journal Detail:
Title:  Journal of cardiothoracic and vascular anesthesia     Volume:  25     ISSN:  1532-8422     ISO Abbreviation:  J. Cardiothorac. Vasc. Anesth.     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-03     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9110208     Medline TA:  J Cardiothorac Vasc Anesth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  817-23     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Affiliation:
Anesthesiology Clinic, University of Thessaly, Larissa, Greece.
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