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Effect of Long-Term Thoracic Epidural Analgesia on Refractory Angina Pectoris: A 10-Year Experience
Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
Högland Hospital, Eksjö, Sweden.
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2012 (English)In: Journal of Cardiothoracic and Vascular Anesthesia, ISSN 1053-0770, E-ISSN 1532-8422, Vol. 26, no 5, 822-828 p.Article in journal (Refereed) Published
Abstract [en]

Objectives

In patients with refractory angina, the adjuvant effects of long-term home self-treatment with thoracic epidural analgesia on angina, quality of life, and safety were evaluated.

Design

A prospective, consecutive study.

Setting

A university hospital.

Participants and Intervention

Between January 1998 and August 2007, 152 consecutive patients with refractory angina began treatment with thoracic epidural analgesia by intermittent injections of bupivacaine (139 home treatment and 13 palliative). Data were collected until August 2008; therefore, the follow-up for each patient was between 1 and 9 years.

Measurements and Main Results

All but 7 of the patients improved symptomatically, and the improvement was maintained throughout the period of treatment (median = 19 months; range, 1 month-8.9 years). After 1 to 2 weeks, the median (interquartile range [IQR]) Canadian Cardiovascular Society angina class decreased from 4.0 (3.0-4.0) to 2.0 (1.0-2.0), the mean ± standard deviation frequency of anginal attacks decreased from 36 ± 19 to 4.4 ± 6.8 a week, the nitroglycerin intake decreased from 27.7 ± 15.7 to 2.7 ± 4.9 a week, and the median (IQR) overall self-rated quality of life assessed by the visual analog scale increased from 25 (20-30) to 70 (50-75) (all p < 0.001). About one-third of the patients had a dislodgement of the epidural catheter. Apart from 1 epidural hematoma that appeared in 1 patient with a previously undiagnosed bleeding defect, no other serious catheter-related complications occurred.

Conclusions

Long-term self-administered home treatment with thoracic epidural analgesia is a safe, widely available adjuvant treatment for patients with severe refractory angina. It produces symptomatic relief of angina and improves quality of life. The technical development of the method to protect the catheter against dislodgement is needed.

Place, publisher, year, edition, pages
Saunders Elsevier, 2012. Vol. 26, no 5, 822-828 p.
Keyword [en]
coronary artery disease, refractory angina pectoris, horacic epidural analgesia, quality of life
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-84740DOI: 10.1053/j.jvca.2012.01.047ISI: 000309020900012OAI: oai:DiVA.org:liu-84740DiVA: diva2:561495
Note

Funding Agencies|Research Board of the County Council of Ostergotland, Ostergotland, Sweden||

Available from: 2012-10-19 Created: 2012-10-19 Last updated: 2017-12-07

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Richter, ArinaCederholm, IngemarFredrikson, MatsJanerot Sjöberg, Birgitta

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Richter, ArinaCederholm, IngemarFredrikson, MatsJanerot Sjöberg, Birgitta
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CardiologyFaculty of Health SciencesDepartment of Cardiology in LinköpingThoracic SurgeryDepartment of Thoracic and Vascular SurgeryOccupational and Environmental MedicineDepartment of Medical and Health SciencesBiomedical InstrumentationThe Institute of TechnologyDepartment of Clinical Physiology in Linköping
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Journal of Cardiothoracic and Vascular Anesthesia
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