Role of inj. ropivacaine (0.2%) in thoracic epidural analgesia for off- pump coronary artery bypass grafting surgery

Background: Thoracic epidural anaesthesia (TEA) in coronary bypass surgery provides an excellent analgesia and helps in early recovery but the use of 0.2% Ropivacaine in TEA for off pump coronary artery bypass surgery (OPCAB) is not well documented in the literature. Methods: After ethics committee approval, sixty patients were randomized into two groups. The General Anesthesia (GA) group (n=30) received Inj. Midazolam (0.1mg/kg) and Inj. Fentanyl (10mcg/kg) for induction. TEA was installed more than one hour before giving heparin at T5–T6 / T6-T7 level in GA+TEA group (n=30) and continuous infusion of 0.2% Ropivacaine @ 5-7 ml/hr intraoperatively was started and continued 24 hours in the postoperative period after extubation. Results: TEA decreased heart rate (HR) but maintained arterial pressures and reduced the consumption of fentanyl and pancuronium significantly (P<0.001) as compared to GA group. In the postoperative period following extubation, heart rate, arterial pressures and CVP were maintained as pain control was superior in GA+TEA group. There was no neurological complication related to TEA. Conclusions: We conclude that TEA using 0.2% Ropivacaine along with GA improves hemodynamics during and after OPCAB surgery, significantly reduces the intraoperative anaesthetic drug requirement and more effective in postoperative pain control.