ESRA19-0088 Postoperative patient controlled epidural or intravenous patient controlled epidural or intravenous pain treatment after one stage unilateral hybrid atrial fibrillation ablation?

Background and aims Finding the best pain treatment approach after one-stage hybrid AF ablation surgery is difficult as cardiac, thoracic and diaphragmatic nerve endings are sensitized. We hypothesised that a patient-controlled postoperative epidural pain treatment with high thoracic (T4) epidural ropivacaine (EA) would provide superior pain relief when compared with an intravenous patient controlled piritramide pump (IA). Methods This ethically approved with written informed consent, prospective study in 69 consecutive patients compared postoperative pain report, pain location and breathing mode. A standardized combined anaesthesia method with inotropic support (if requested) was used during surgery. The simultaneous thoracoscopic and endovascular ablation surgery consisted of a stepwise ablation protocol. EA consisted of ropivacaine 2 mg/ml set at 4 ml/h with a PCEA regimen of: 2 ml/30 min. The IA group received PCA regimen of 2 mg of piritramide every 7 min with 30 mg/4h maximal dose. Parameters assessed after surgery were pain with VAS scores, pain locations, breathing frequency and mode, sleep, duration of drain and hospital stay. To ease pain patients also received: paracetamol, diclofenac (when possible), morphine, colchicine and aspirin (pericarditis suspicion). Results 50 patients with refractory AF were recruited. Similar peak dynamic pain scores and referred pain localisations, but lesser initial respiratory comfort and sleep recuperation and a tendency to more PONV were observed in IA patients. Postoperative suspected ablation pericarditis incidence was high. Conclusions Both postoperative EA or IA pain treatments are valuable options yielding no differences in pain report after surgery. But EA may initially improve the patient’s respiratory ease.