Influence of patient-controlled i.v. analgesia with opioids on supraventricular arrhythmias after pulmonary resection

Abstract

Background: Postoperative supraventricular arrhythmias (SVA) are common after pulmonary resection and autonomic imbalance is thought to be one of the triggers. Opioids can increase parasympathetic activity and may balance heightened sympathetic tone after operation. We have examined the effect of postoperative patient-controlled analgesia (PCA) with opioids on postoperative SVA. Methods: Forty-eight patients were randomly assigned to two groups. The GA group received general anaesthesia PCA and PCA with opioids (fentanyl 6 μg ml-1 and tramadol 3 mg ml-1). The GEA group received combined general/epidural anaesthesia plus patient-controlled epidural analgesia (PCEA). Holter recording was completed for 12 h before operation and 12 and 48 h after operation. The incidence of supraventricular tachycardias (SVT), atrial fibrillation, and supraventricular ectopic beats (SVEBs) was evaluated. Results: The incidence of postoperative SVT was significantly lower in the GA group than in the GEA group (3/22 vs 10/22, P=0.021). The incidence of postoperative SVEBs was not statistically different between the groups, but the frequency of postoperative SVEBs increased less in the GA than the GEA group (7/22 vs 15/22, P=0.016). Conclusions: PCA with opioids (fentanyl and tramadol) can reduce postoperative SVA after pulmonary resection compared with PCEA with ropivacaine. © The Author [2009]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.