Neurologische Störungen, chronische Schmerzen und Lebensqualität nach Herzoperationen mit Epiduralanästhesie

In diese Arbeit wird untersucht, ob eine perioperativ begonnene thorakale Epiduralanalgesie (EDA) die Lebensqualität, dass Auftreten chronischer Schmerzen und neurologischer Störungen nach einer elektiven aorto-coronare Bypassoperation (ACB-Operation) langfristig beeinflusst. Hierzu wurden zwei...

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Bibliographic Details
Main Author: Behrensdorf, René Marcel
Contributors: Eberhart, Leopold (Prof. Dr.) (Thesis advisor)
Format: Dissertation
Language:German
Published: Philipps-Universität Marburg 2011
Subjects:
TEA
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Table of Contents: This study analyses if there are olong-term effects in using perioperative started thoracic epidural analgesia (TEA)on the health related quality of life, the development of chronic pain and neurological disorders, after elective coronary artery bypass graft surgery (CABG). For this reason two cohorts were analysed. One of them was treated with TEA. The data for this retrospective study was collected using computer-assisted telephone interviews (CATI) in spring 2008. Both cohorts were operated on between 2004 and 2006 at the University Hospital of Philipps University, Marburg. The health-related quality of life was measured using the SF-12 questionnaire. Data collected on pain, neurological disorders, special information on the TEA and health condition were standardized and evaluated. The significance level for the statistical analysis (t- tests and chi-square tests) was set at p< 0,05 and the Kolmogoroff-Smirnov test was used for testing normal distribution. 944 persons were operated on and of these persons 296 fulfilled the defined exclusion criteria. 648 persons were potential candidates for the phone interview. Of these 648 persons, 397 were interviewed (209 in the cohort „catheter“ and 188 in the control group), a response rate of 61 %. In the operation no significant differences could be found between the cohorts (in all figures, the first figure refers to the cohort „catheter“ and the second to the control group) in health status (height, weight, ejection fraction, other diseases) and age (64,7/ 65,6). The analysis of the SF-12 does not show significant differences, neither between the cohorts overall nor according to gender. In the following cases significant differences were detected in comparison with the normative sample and the normative sample with current illnesses or chronic diseases: In comparison with the normative German sample, both cohorts achieved significantly lower values on the physical health summary scale (test value: 49,03; 47,02/45,39). Males in both cohorts (test value: 50,22; 47,48/46,23) and females in the control group (test value: 47,93; 41,25) achieved significantly lower values on the physical health summary scale. Only in the control group, after dividing according to gender in comparison with the normative sample with current illnesses or chronic diseases (test value: ♀ 45,16, ♂ 47,71) were significantly lower values detected in both subgroups (♀41,27, ♂46,23). Significantly higher values were not found. Significantly higher values were found on the mental health summary scale for both cohorts (54,26/53,48) in comparison with the normative German sample (test value: 52,24) and after dividing into subgroups, only among males in the cohort „catheter“ (test value: 53,25; 54,87). Significantly higher values were found on the mental health summary scale for both cohorts (54,26/ 53,48) in comparison with the normative sample with current illnesses or chronic diseases (test value: 51,24), for females from the control group (test value: 50,54; 54,13) and for males from the cohort „catheter“ (test value: 52,09; 54,87). Significantly lower values were not found. There was no significant difference in chronic pain (15%/ 17%), post-operative pain (59,8%/ 57,4%), pain one week after operation (57,4%/ 51,6%) and pain intensity (immediately 4,7/ 5,3, after one week 4,0/ 4,3, chronic 4,3/ 4,0) between the cohorts. No significant difference was found in neurological disorders (32,1%/ 29,3%) nor in restricted movement (3,3%/ 5,9%) between the cohorts. 93% of people remembered the insertion of the TEA and 80% would re-apply for a TEA. The average lengths of TEA stay was five days and the most-used sector for the TEA-catheter was in 46,9% TH1/ TH2. This retrospective cohort examination cannot show a significant impact of TEA by elective coronary artery bypass graft surgery on chronic and acute pain, neurological disorders, restricted movement nor any definite effects on the health-related quality of life.