Sen Amitabh Chanchal, Rajan Sunil, Balachandran Rakhi, Kumar Lakshmi, Nair Suresh Gangadharan
Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
Anesth Essays Res. 2017 Jan-Mar;11(1):105-109. doi: 10.4103/0259-1162.186613.
Two-thirds of patients undergoing coronary artery bypass grafting (CABG) surgery report moderate to severe pain, particularly with ambulatory or respiratory effort.
The aim of this study is to compare the analgesic effect of perioperative thoracic epidural fentanyl with bupivacaine and intravenous fentanyl in patients undergoing CABG surgery.
The study was a prospective, randomized, nonblinded comparative study.
A total of 60 patients coming under the American Society of Anesthesiologists Class III who were posted for CABG surgery were recruited in this study. The patients were randomized into one of two groups, higher thoracic epidural analgesia (HTEA) group receiving general anesthesia with thoracic epidural analgesia (TEA) in the postoperative period, and intravenous fentanyl analgesia group receiving general anesthesia with fentanyl infusion in the postoperative period. The pain was assessed at 4 h after extubation when the patient was fully awake, then at 8, 12, 18, and 24 h. Both groups received intravenous tramadol 100 mg as rescue analgesia whenever visual analog scale score was 5 and above. Heart rate, mean arterial pressure (MAP), sedation scores, and physiotherapy cooperation were also assessed.
The numerical data were analyzed using an independent -test, repeated-measures ANOVA, and Mann-Whitney U-test.
Pain at rest and on cough was significantly lower in HTEA patients as compared to control group. Patients HTEA group got less frequent rescue analgesia than the control group. Physiotherapy cooperation was significantly better in HTEA patients at 4, 12, and 24 h postextubation. They also had significantly lower heart rate, MAP, and sedation scores.
Perioperative TEA using fentanyl with bupivacaine provided optimal postoperative analgesia at rest and during coughing in patients following CABG surgery as compared to postoperative analgesia with intravenous fentanyl. It also resulted in optimal postoperative hemodynamic status, good cooperation to chest physiotherapy with less sedation.
接受冠状动脉旁路移植术（CABG）的患者中有三分之二报告有中度至重度疼痛，尤其是在活动或呼吸用力时。
本研究的目的是比较围手术期胸段硬膜外给予芬太尼联合布比卡因与静脉注射芬太尼对接受CABG手术患者的镇痛效果。
该研究是一项前瞻性、随机、非盲对照研究。
本研究共纳入60例美国麻醉医师协会Ⅲ级、拟行CABG手术的患者。患者被随机分为两组，即高位胸段硬膜外镇痛（HTEA）组，术后接受全身麻醉并联合胸段硬膜外镇痛（TEA）；静脉注射芬太尼镇痛组，术后接受全身麻醉并静脉输注芬太尼。在患者完全清醒后拔管后4小时进行疼痛评估，然后在8、12、18和24小时进行评估。当视觉模拟量表评分达到5分及以上时，两组均给予静脉注射曲马多100mg作为补救镇痛。还评估了心率、平均动脉压（MAP）、镇静评分和物理治疗配合情况。
数值数据采用独立样本t检验、重复测量方差分析和曼-惠特尼U检验进行分析。
与对照组相比，HTEA组患者静息和咳嗽时的疼痛明显减轻。HTEA组患者接受补救镇痛的频率低于对照组。HTEA组患者在拔管后4、12和24小时的物理治疗配合情况明显更好。他们的心率、MAP和镇静评分也明显更低。
与术后静脉注射芬太尼镇痛相比，围手术期使用芬太尼联合布比卡因的TEA为接受CABG手术的患者提供了静息和咳嗽时的最佳术后镇痛效果。它还导致了最佳的术后血流动力学状态，对胸部物理治疗的良好配合以及较少的镇静作用。
