Epidurally administered local anesthetics may decrease both the incidence and severity of post-operative arrhythmias – in Oka et al.’s study of 50 patients randomized to morphine versus bupivacaine epidurals, the incidence of arrhythmias fell from 28% to 4.35% [Oka T et al. Anesth Analg 93: 253, 2001; FREE Full-text at Anesthesia & Analgesia]. Possible mechanisms include changes in the myocardial refractory period (lidocaine is a class Ia anti-arrhythmic, i.e. sodium channel blocker), as well as decrease diastolic blood pressures and improve endocardial/epicardial blood flow ratio [Oka T et al. Anesth Analg 93: 253, 2001; FREE Full-text at Anesthesia & Analgesia].
Obviously, thoracic epidural analgesia plays an important in Post-Thoracotomy Care.
