Introduction: Patients undergoing lung cancer surgery have a high risk of developing postoperative atrial fibrillation. The frequency of postoperative atrial fibrillation (POAF) in thoracic surgery is 12-40%.
Objectives: We aimed to evaluate the impact of thoracic epidural analgesia on the frequency of POAF in patients undergone lung cancer surgery.
Methods: 472 adult patients undergoing lung cancer surgery (lobectomy - 330, pneumonectomy - 142) were divided into two groups:
1) general anesthesia (GA) n=300 (propofol, ketamine, fentanyl, sevoflurane), 2) combined general-epidural anesthesia and postoperative epidural analgesia for a 5-6 days (CA) n=172 (propofol, ketamine, fentanyl, sevoflurane, ropivacaine).
In postoperative period all patients in both groups received standard systemic analgesia with opioid analgesics, NSAIDs, paracetamol.
Results: In GA the frequency of POAF was 15,3% (46/300). The overall incidence of POAF did not differ between patients undergone pneumonectomy and lobectomy in GA (21,6% (16/74) vs. 13,7% (30/226), respectively (p=0,08)).
In CA the frequency of POAF was significantly reduced versus GA (8,7% (15/172) vs. 15,3% (46/300), respectively (p=0,04)). Patients undergone pneumonectomy suffered from postoperative atrial fibrillation in 13,2% (9/68) of cases and lobectomy in 6,2% (6/104) of cases in CA (p=0,09). The frequency of POAF in patients undergone pneumonectomy did not differ significantly between the groups (p=0,19), but the frequency of postoperative atrial fibrillation in patients undergone lobectomy was significantly reduced in CA versus GA (p=0,04).
Conclusions: Postoperative thoracic epidural analgesia significantly decreases the frequency of postoperative atrial fibrillation in patients undergoing extended lungs surgery. It most effective in patients undergoing lobectomy.