High Thoracic Epidural Anaesthesia and Post Operative Analgesia for Fast Tracking Patients undergoing CABG: Our Initial Experience.

This prospective study was carried out is 250 patients undergoing CABG. The aim of this study was to assess the effects of high thoracic epidural anaesthesia during CABG, along with modified general anaesthsia; facilitate early extubation and fast tracking post operatively; evaluate effect on post-operative analgesia and discuss difficulties in patient selection for high thoracic epidural catheterization. 250 patients undergoing CABG over a period of nine months were included in this study. Patients with age >64 yrs, weight < 50 kg, EF < 50%, redo surgery, recent MI, receiving aspirin or ticlopidine or heparin were excluded from the study. A thoracic epidural catheter was inserted evening before surgery at T1-2 or T2-3 interspace. A total of 75 patients (30%) were found suitable to be included in this study. On table extubation or early extubation (within 3 hours) was achieved in 85% of cases. Post operative infusion of 0.1% Bupivacaine and 2 microg/ml Fentanyl was given epidurally through a PCA system for analgesia for 48-72 yrs. High thoracic epidural anaesthesia and modified GA regimen were helpful in fast tracking and early extubation of patients. Over 90% patients were discharged on day 5, from the hospital. All these patients experienced significantly less pain and discomfort following CABG. The procedural difficulties for inserting high thoracic epidural catheter were overcome with increasing experience.