Journal of cardiothoracic and vascular anesthesia · 2010
Thoracic epidural analgesia with levobupivacaine for 6 postoperative days attenuates sympathetic activation after thoracic surgery.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
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Simeoforidou Marina, Vretzakis George, Bareka Metaxia, Chantzi Eleni, Flossos Andreas, Giannoukas Athanasios, Tsilimingas Nikolaos
Аннотация
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.
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.
Предметные рубрики MeSH
AgedAnalgesia, EpiduralAnalgesia, Patient-ControlledAnalgesics, OpioidAnesthesia, GeneralAnesthetics, LocalAutonomic Nervous SystemBlood PressureBupivacaineElectrocardiography, AmbulatoryFemaleHeartHeart RateHumansLevobupivacaineMaleMiddle AgedMorphinePneumonectomyPostoperative CareProspective StudiesSympathetic Nervous SystemThoracic Surgical ProceduresThoracic VertebraeThoracoscopy