Thoracic epidural analgesia: Its role in postthoracotomy atrial arrhythmias

Objective: To determine the effects of thoracic epidural analgesia (TEA) ma nagement on the incidence of atrial arrhythmias (AAs) after thoracotomy for lung resection. Design: Retrospective. Setting: A major university medical center. Participants: The medical records of 185 consecutive patients who underwent thoracotomy between 1993 and 1997 were reviewed; patients with TEA only we re included in the analysis. Interventions: None. Measurements and Main Results: There was a 20% incidence of AAs after thora cotomy. Preoperative predictors of AAs were age >65 years, cardiac history, and an abnormal electrocardiogram (ECG). There was a temporal relationship between epidural catheter removal and occurrence of AAs. Fourteen patients developed AAs before TEA catheter removal, whereas 29 patients developed A As after TEA catheter removal (p = 0.01), There was no relationship between anatomic site of epidural catheter placement or choice of epidural agent a nd AAs. Conclusions:AAs after thoracotomy were common. These AAs were associated wi th increased age, cardiac history, abnormal EGG, increased cost, increased length of hospital stay, and time of epidural catheter removal. Although a cause-and-effect relationship cannot be inferred from this study, the prese nce or absence of TEA was found to have a temporal relationship with the in cidence of AAs. Copyright (C) 2000 by W.B. Saunders Company.