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26355 - A RETROSPECTIVE STUDY OF EPIDURALS POST-LUNG TRANSPLANTATION

University Of Alberta, Edmonton, ALBERTA, Canada

INTRODUCTION: Thoracic epidural analgesia (TEA) is a modality used to achieve good analgesia and improved respiratory function after major surgeries, including lung transplants with the associated thoracotomy. Subsequently, quicker extubation and shorter ICU stays can help patients avoid complications. The Göteborg Lung Transplant Group in Sweden reported that early extubation was related to routine preoperative TEA and provision of continuous positive airway pressure (CPAP) following endotracheal tube removal.1 Despite this, there is the risk of perioperative epidural complications, including rare but devastating spinal cord damage. In addition, the cases that need cardiopulmonary bypass require anticoagulation which can potentially cause hematoma formation.2 With these concerns, the patients at our institution do not receive TEA until 1–2 days postoperatively. To access the merit of our protocol, we would like to study TEA efficacy, in relation to standard patient controlled analgesia (PCA), regarding: placement safety, earlier extubation, pain management, and length of hospital stay.

METHODS: After ethics approval, the first consecutive 31 charts of lung transplant patients starting from January 2002 were retrospectively examined. Two patients passed away due to surgical and/or medical causes prior to receiving PCA or TEA and were excluded. The parameters investigated include: patient demographics and history, surgical details, TEA and PCA information, coagulation parameters, perioperative complications, extubation timing, and discharge dates.

RESULTS: Table 1 summarizes the chart data collected from 29 lung transplant patients and compares PCA with TEA. There was no significant difference in time to extubation between analgesic modalities. No significant differences were found in other study parameters. Most lung transplant patients required cardiopulmonary bypass.

REFERENCES:

1 J of Cardiothoracic and Vasc Anes 1999; 13: 249–252

2 Anes Clinics of N America 2000; 18: 461–485

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