The Open Anesthesia Journal

Formerly: The Open Anesthesiology Journal

ISSN: ― Volume ,

High Thoracic Epidural Analgesia as an Adjunct to General Anesthesia in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting Alternate Title: High Thoracic Epidural Analgesia

Erdem Cetin1, *, Alper Iynem2, Celal Selcuk Unal1, Ertan Demirdas3
1 Department of Cardiovascular Surgery, Karabuk University Education and Research Hospital, Karabuk, Turkey
2 Department of Anesthesiology, Medikar Hospital, Karabuk, Turkey
3 Departmant of Cardiovascular Surgery, Gulhane Education and Research Hospital, Ankara, Turkey



To investigate the effect of high thoracic epidural analgesia combined with general anesthesia on pain management and postoperative outcomes in patients undergoing off-pump Coronary Artery Bypass Grafting (CABG).

Materials and Methods:

Patients were divided into two groups; Group 1 received general anesthesia and high thoracic epidural anesthesia whereas Group 2 received general anesthesia alone during off-pump coronary artery bypass grafting. Epidural catheters were placed at least 6 hours before transfer to the operating room. An epidural analgesic solution of 0.25% bupivacaine and 10 µg/ml fentanyl was started as continuous infusion at 5 ml/hour and maintained for at least 12 hours after completion of surgery. A 10-cm visual analog scale was used to measure pain at 4th, 6th, 9th and 12th postoperative hours.


Mean time to extubation was similar between two groups (2.45±0.88 vs. 2.59±1.31 for Groups 1 and 2, respectively, p=0.90). In all measurements, mean Visual Analogue Scale VAS scores were significantly lower in Group 1 compared to Group 2 (6.50±1.53 vs. 4.09±1.83 at 4th hour, 6.62±1.55 vs. 3.71±1.85 at 6th hour, 5.83±1.40 vs. 2.93±1.54 at 9th hour and 4.41±1.97 vs. 2.50±1.19 at 12th hour, p<0.001 in each comparison).


Continuous high thoracic epidural analgesia seems to be a good adjunct to general anesthesia, as its pain relief effect becomes obvious at 4th postoperative hour and lasts at least 12th postoperative hour.

Keywords: Coronary artery bypass grafting, High thoracic epidural anesthesia, Pain, Analgesia, Postoperative pain control.

Article Information

Identifiers and Pagination:

Year: 2019
Volume: 13
First Page: 106
Last Page: 110
Publisher Id: TOATJ-13-106
DOI: 10.2174/2589645801913010106

Article History:

Received Date: 24/08/2019
Revision Received Date: 02/10/2019
Acceptance Date: 09/10/2019
Electronic publication date: 24/10/2019
Collection year: 2019

© 2019 Cetin et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Cardiovascular Surgery, Karabuk University Education and Research Hospital, Sirinevler Mah. Alparslan Cad. No: 1, Karabuk, Turkey;
Tel: 05392905659; E-mail:

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