Background: Our aim was to assess the efficacy of thoracic epidural anesthesia (EA) followed by postoperative\r\nepidural infusion (EI) and patient-controlled epidural analgesia (PCEA) with ropivacaine/fentanyl in off-pump\r\ncoronary artery bypass grafting (OPCAB).\r\nMethods: In a prospective study, 93 patients were scheduled for OPCAB under propofol/fentanyl anesthesia and\r\nrandomized to three postoperative analgesia regimens aiming at a visual analog scale (VAS) score < 30 mm at rest.\r\nThe control group (n = 31) received intravenous fentanyl 10 �µg/ml postoperatively 3-8 mL/h. After placement of\r\nan epidural catheter at the level of Th2-Th4 before OPCAB, a thoracic EI group (n = 31) received EA intraoperatively\r\nwith ropivacaine 0.75% 1 mg/kg and fentanyl 1 �µg/kg followed by continuous EI of ropivacaine 0.2% 3-8 mL/h and\r\nfentanyl 2 �µg/mL postoperatively. The PCEA group (n = 31), in addition to EA and EI, received PCEA (ropivacaine/\r\nfentanyl bolus 1 mL, lock-out interval 12 min) postoperatively. Hemodynamics and blood gases were measured\r\nthroughout 24 h after OPCAB.\r\nResults: During OPCAB, EA decreased arterial pressure transiently, counteracted changes in global ejection fraction\r\nand accumulation of extravascular lung water, and reduced the consumption of propofol by 15%, fentanyl by 50%\r\nand nitroglycerin by a 7-fold, but increased the requirements in colloids and vasopressors by 2- and 3-fold,\r\nrespectively (P < 0.05). After OPCAB, PCEA increased PaO2/FiO2 at 18 h and decreased the duration of mechanical\r\nventilation by 32% compared with the control group (P < 0.05).\r\nConclusions: In OPCAB, EA with ropivacaine/fentanyl decreases arterial pressure transiently, optimizes myocardial\r\nperformance and influences the perioperative fluid and vasoactive therapy. Postoperative EI combined with PCEA\r\nimproves lung function and reduces time to extubation.
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