COMPARATIVE-EVALUATION OF INTRAPLEURAL AND THORACIC EPIDURAL ANALGESIA FOR POSTOPERATIVE PAIN RELIEF AFTER MINIMALLY INVASIVE DIRECT CORONARY-ARTERY BYPASS-SURGERY

Objective: To compare the efficacy of thoracic epidural analgesia (TEA ) and intrapleural analgesia (IPA) after minimally invasive direct cor onary artery bypass (MIDCAB) surgery with regard to quality of analges ia and complications. Design: A prospective, randomized study. Setting : A specialty research hospital. Participants: Fifty consenting adults scheduled for MIDCAB surgery. Interventions: All patients underwent e lective MIDCAB surgery. Patients in the TEA group (n = 25) had an epid ural catheter inserted in the fourth to fifth thoracic interspace and those in the IPA group (n = 25) had an intrapleural catheter inserted in the sixth to seventh intercostal space intraoperatively under visio n. Measurements and Main Results: Parameters evaluated after administr ation of bupivacaine (8 mL of 0.25% in the TEA group and 20 mL of 0.25 % in the IPA group) on first demand included visual analog scale (VAS) pain scores, cardiovascular and respiratory (clinical, blood gases) f unction, wakefulness, supplemental analgesic requirement, and complica tions. Measurements were made at 2-hour intervals for the next 12 hour s. VAS scores were significantly lower at 2, 6, 8, and 12 hours in the IPA group (TEA = 3.5, 4.5, 4.9, 4.6; IPA = 2.2, 3.6, 3.5, 3.7). There were no significant differences in hemodynamic or respiratory paramet ers or postoperative requirement for supplemental analgesia. In the TE A group, three patients had catheter migration and four had severe bac kache. Conclusion: IPA is a safe and effective technique for postopera tive analgesia after MIDCAB surgery and has a low complication rate co mpared with IEA. Careful positioning, chest tube clamping, and anchori ng of the catheter are mandatory for IPA to be effective. Copyright (C ) 1998 by W.B. Saunders Company.