The Effect Of Epidural Versus Intravenous Analgesia On The Postoperative Cardiac Events

Objectives" To investigate different postoperative analgesia on stress levels and perioperative cardiovascular events.Methods:164 cases of selective abdominal and lower limb surgery in 2007 ACC / AHA non-cardiac surgery perioperative cardiovascular evaluation and treatment guidelines for patients with low-risk and medium-risk group,were randomized into 5 groups:pethidine group(group D,n = 42),epidural group(group E,n = 30), morphine group(group M,n = 30),fentanyl group(group F,n = 30),remifentanil group(group R,n = 32).Five groups were received composite-inhalation general anesthesia,in addition group E before induction carrying out epidural catheterization,only administer the amount of test grant to confirm catheter at epidural.To observation of adverse cardiovascular events,all patients contacted 3 leads ambulatory electrocardiograph monitored(MV1,MV5,MavF) after the end of operation for 48 hours,and use of appropriate drugs for analgesia.In addition to Group D returned to the original section(as the control group),other groups enter the SICU and control Price-Henty score 1-2 points.Respectively before induction(TO), after 2h(T2),after 24h(T24),after 48h(T48) collected blood samples in order to measured adrenocorticotropic hormone(ACTH) and cortisol(Cort) by radioimmunoassay.At the same time,records basic information in intraoperative and postoperative.Results:There were no differences in preoperative,introperative and postoperative parameters between five groups.There were no statistics differences between five groups when the Price-Henry scale was compared.The concentration of ACTH and cortisol were similar in the 5 groups before operation,and were remarkably increased postoperatively.The stress level of E group is lower than the other 4 groups in T24 and T48.There were no differences in the incidence of cardiovascular events between five group.Conclusion:Postoperative epidural analgesia can reduce the stress level, but compared with intravenous opioid analgesia,the incidence of postoperative cardiovascular events is not significant difference.