Long-term home self-treatment with high thoracic epidural anesthesia in patients with severe coronary artery disease.

Abstract

Twenty patients with severe coronary artery disease (CAD) and refractory unstable angina who had sustained a recent myocardial infarction (n = 7) or who were considered as either inoperable (n = 10) or at severe operative risk (n = 3) were treated with high thoracic epidural anesthesia (TEA) via a tunneled epidural catheter for long-term self-use at home. They were instructed to use sublingual nitrates as their first treatment for angina and to inject 3-5 mL of bupivacaine (5 mg/mL) into the epidural catheter only for severe episodes. The epidural catheters were maintained for long periods (mean, 6 mo; longest treatment, 3.2 yr). Most patients expressed great satisfaction with the TEA treatment. The epidural bupivacaine injections induced complete pain relief within a short period. There were no severe adverse events induced by the treatment, and only one case of tachyphylaxis was documented. There was a decrease in the frequency of epidural injections with time from an average of 1.86 +/- 0.5 to 0.96 +/- 1.1 injections/d from the first to the last week of treatment (n = 18) (P < 0.001). This decrease was most evident when comparing the last week of TEA treatment in patients having TEA < 1 mo (n = 5) with patients having TEA > 6 mo (n = 5), an average of 2.00 +/- 0.47 vs 0.25 +/- 0.10 injections/d, respectively (P < 0.01). Seven patients had either coronary bypass surgery (n = 6) or spinal cord electrical stimulation (n = 1) after an average of 42 days of successful TEA treatment (range, 14-70 days).(ABSTRACT TRUNCATED AT 250 WORDS)