Long-Term Home Self-Treatment with High Thoracic Epidural Anesthesia in Patients with Severe Coronary Artery Disease

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Abstract
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). Five patients died during the observation period; however, none of the deaths seemed related to the TEA treatment. In these patients, long-term home self-treatment with TEA produced a satisfactory quality of life. The decreased need for injections with time suggests that there might be a long-term beneficial effect of TEA in severe ischemic heart disease. Address correspondence and reprint requests to Sture G. Blomberg, MD, PhD, Department of Anesthesiology and Intensive Care Medicine, Sahlgren Hospital, 413 45 Gothenburg, Sweden. The author wishes to thank Dr. S.-E. Ricksten, Director of the Cardiothoracic ICU, and Dr. H. Emanuelsson, Chairman of the Division of Cardiology, Sahlgren Hospital, Gothenburg, Sweden, for valuable comments. Special thanks go to Rowena Purcell, research assistant, for her magnificent assistance in preparing the manuscript. Accepted for publication March 29, 1994. © 1994 International Anesthesia Research Society...

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