| Abstract: |
Epidural analgesia has been shown to be have great advantages in different types of surgery. It has gained popularity in cardiac surgery over the last decade. A variety of epidural solutions have been used in cardiac surgery. In this study, we aimed to study the effect of adding opioids to local anesthetics in thoracic epidural catheter in patients undergoing elective cardiac surgery.Methods: In a randomized prospective study, 60 patients, ASA II & III, scheduled for cardiac surgery, with age range (10-65) years old received thoracic epidural analgesia in combination with general anesthesia. All patients received bupivacaine 0.25% ( 0.1 ml / kg ) as loading dose in the thoracic epidural catheter then Patients were divided randomly into three groups; 20 patients each: group (B) received 0.1 ml/kg/hour bupivacaine 0.125% as continuous infusion, group (BF) received 0.1 ml/kg/hour bupivacaine 0.125% plus fentanyl 4 μg/ml as continuous infusion and group (BM) received 0.1 ml/kg/hour bupivacaine 0.125% plus morphine 0.05 mg/ml as continuous infusion. Haemodynaemic stability (heart rate, systolic and diastolic blood pressure), arterial blood gases, respiratory function, postoperative pain scores, epidural infusion rates and complications were compared between the three studied groups.Results: Patient characteristics, haemodynaemic stability, respiratory function were not different between the three studied groups. Postoperative pain control was very good in almost all patients. Postoperative pain scores, epidural infusion rates and postoperative complications specially paraesthesia in dermatomes C8 and T1 did not vary between the three studied groups. There was no neurological complications related to thoracic epidural analgesia in this study.Conclusion: We concluded that Intraoperative and postoperative analgesia with thoracic epidural analgesia is equally effective with bupivacaine alone, bupivacaine with fentanyl and bupivacaine with morphine. The addition of fentanyl and morphine to bupivacaine didn’t change haemodynaemic stability, respiratory function, epidural infusion rates and thoracic epidural analgesia related complications in generally anesthetized cardiac surgery patients.
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