Effect of Thoracic Epidural Analgesia for Thoracotomy on the Occurrence of AF

Study Overview
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Brief Summary
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Thoracic epidural anesthesia and analgesia for patients undergoing lung resection can reduce the occurrence of AF if it is continued for six postoperative days instead of just three.

Detailed Description
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THEA is considered a very effective technique of providing intra and post-operative analgesia for thoracic surgical procedure and it seems that can also be effective in reducing the incidence of postoperative AF in patients undergoing lung resection. Nevertheless the timing of stopping the epidural analgesia and its further substitution with other therapies, remains unclear. In this study patients who are scheduled for lung resection surgery will undergo the surgery under combined general anesthesia with volatile anesthetics and thoracic epidural anesthesia. Immediately after surgery the patients will be divided into two groups: those who will receive thoracic epidural analgesia for 6 days those who will receive thoracic epidural analgesia for 3 days and will then switch to intravenous morphine for another 3 days All the patients will be monitored daily for arrythmias

Official Title
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Effect of Thoracic Epidural Analgesia for Thoracic Surgery on Arrhythiogenesis

Conditions
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Posterolateral Thoracotomy, Lung Resection, Thoracic Epidural Analgesia, Sympathetic Outflow, Atrial Fibrillation

Intervention / Treatment
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* Other: Thoracic Epidural Analgesia (TEA)
* Other: TEA followed by Intravenous morphine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: lung resection pneumonectomy Exclusion Criteria: Patient refusal AF (present or in the past contraindications for epidural catheter placement

Ages Eligible for Study
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Minimum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: 6 days TEA<br>Postoperative analgesia for the first six postoperative days with TEA and daily monitoring for arrhythmia | Other: Thoracic Epidural Analgesia (TEA)<br> <br> |
| Active Comparator: 3 days TEA and 3 days intravenous morphine<br>Postoperative analgesia for the first three postoperative days with TEA followed for the next three days with intravenous morphine, and daily monitoring for arrhythmia | Other: TEA followed by Intravenous morphine<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Occurrence of AF | Every day, for the first 6 postoperative days, the investigators will record an ECG of the patient, and look after for any presence of AF | 6 postoperative days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quality of analgesia | The investigators will record the quality of analgesia, as it can be measured with VAS, for the 6 first postoperative days for all patients | 6 postoperative days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Thoracotomy, Thoracic epidural analgesia, Arrythmiogenesis, Atrial fibrillation, Sympathetic outflow