Effects of thoracic epidural analgesia on exercise‐induced myocardial ischaemia in refractory angina pectoris. Issue 4 (30th October 2018)

• Record Type: Journal Article
• Authors: Gonon, Adrian; Richter, Arina; Cederholm, Ingemar; Khan, Jehangir; Novak, Jacek; Milovanovic, Micha; Janerot‐Sjoberg, Birgitta
• Is Part Of: Acta anaesthesiologica scandinavica. Volume 63:Issue 4(2019:Apr.)
• Page Start: 515
• Page End: 522
• Publication Date: 2018-10-30
• Subjects: anti‐ischaemic effect -- myocardial scintigraphy -- placebo‐controlled study -- quality of life -- refractory angina pectoris -- thoracic epidural analgesia; Anesthesiology -- Periodicals; Critical care medicine -- Periodicals; 617.9605
• DOI: 10.1111/aas.13291
• Languages: English
• ISSNs: 0001-5172

Abstract

Abstract : Background: Thoracic epidural analgesia (TEDA) was offered to patients with refractory angina pectoris. Our primary objectives were to evaluate TEDAs´ influence on quality of life (QoL, base for power analysis), and hypothesising that TEDA with bupivacaine during 1 month counteracts exercise‐induced myocardial hypoperfusion and increase physical performance. Methods: Patients with refractory angina and exercise inducible hypoperfusion, as demonstrated by myocardial perfusion imaging (MPI), were randomised to 1‐month treatment with TEDA with bupivacaine (B‐group, n = 9) or saline (P‐group, n = 10) in a double‐blind fashion. MPI and bicycle ergometry were performed before TEDA and after 1 month while subjective QoL on a visual analogue scale (VAS) reported by the patients was checked weekly. Results: During this month VAS (mean [95%CI]) increased similarly in both groups (B‐group from 33 [18‐50] to 54 [30‐78] P < 0.05; P‐group from 40 [19‐61] to 48 [25‐70] P < 0.05). The B‐group reduced their exertional‐induced myocardial hypoperfusion (from 32% [12‐52] to 21% [3‐39]; n = 9; P < 0.05), while the P‐group showed no significant change (before 21% [6‐35]; at 1 month 23% [6‐40]; n = 10). MPI at rest did not change and no improvement in physical performance was detected in neither of the groups. Conclusions: In refractory angina, TEDA with bupivacaine inhibits myocardial ischaemia in contrast to TEDA with saline. Regardless of whether bupivacaine or saline is applied intermittently every day, TEDA during 1 month improves the quality of life and reduces angina, even when physical performance remains low. A significant placebo effect has to be considered.