Post-thoracotomy analgesia--comparison epidural fentanyl to intravenous pethidine.

BACKGROUND AND METHODS To evaluate the efficacy of postthoracotomy analgesia with intermittent epidural fentanyl. 50 patients were allocated randomly into 2 groups. The first group received intermittent epidural fentanyl and the second group received intermittent intravenous analgesia using pethidine. The variables studied were: pain score; total amount of additional intravenous opioid analgesia, and ventilatory function parameters [forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and FEV1/FVC ratio]: RESULTS In the first postoperative day, pain scores were higher in the epidural group (P = 0.034), but there was no significant difference between mean pain scores in the second and third days (P = 0.61, P = 0.15, respectively). On all three days, significantly more additional analgesics were required in the epidural group. A difference was found between both groups in the post- to pre-operative FEV1, FVC and FEV1/FVC ratios, with the better preservation of the ventilatory function in the epidural group (P = 0.001, 0.013, <0.0001, respectively). CONCLUSION The analgesic effect of intermittent epidural fentanyl is not adequate and postoperative pain relief has not any significant advantage over the more easily-applied intravenous analgesia. However, better preservation of ventilatory function makes epidural fentanyl a useful adjunct analgesia in reduction of post-thoracotomy pulmonary complications.

[1]  P. Aceto,et al.  Use of levobupivacaine for the treatment of postoperative pain after thoracotomies. , 2005, Minerva anestesiologica.

[2]  F. Gao,et al.  Pain control for thoracotomy , 2005 .

[3]  D. Orkin,et al.  One shot spinal morphine injection for postthoracotomy pain control in children , 2004, Paediatric anaesthesia.

[4]  I. Matot,et al.  Epidural clonidine, bupivacaine and methadone as the sole analgesic agent after thoracotomy for lung resection * , 2004, Anaesthesia.

[5]  E. Kalso,et al.  Post‐thoracotomy pain after thoracic epidural analgesia: a prospective follow‐up study , 2003, Acta anaesthesiologica Scandinavica.

[6]  D. Zurakowski,et al.  The Effects of Thoracic Epidural Analgesia with Bupivacaine 0.25% on Ventilatory Mechanics in Patients with Severe Chronic Obstructive Pulmonary Disease , 2001, Anesthesia and analgesia.

[7]  S. Azad.  Perioperative pain management in patients undergoing thoracic surgery , 2001, Current opinion in anaesthesiology.

[8]  M. Silvasti,et al.  Continuous epidural analgesia with bupivacaine‐fentanyl versus patient‐controlled analgesia with i.v. morphine for postoperative pain relief after knee ligament surgery Note , 2000, Acta anaesthesiologica Scandinavica.

[9]  P. White,et al.  Effects of Ketorolac Versus Bupivacaine Coadministration During Patient-Controlled Hydromorphone Epidural Analgesia After Thoracotomy Procedures , 1997, Anesthesia and analgesia.

[10]  B. Bake,et al.  The Analgesic Efficacy and Adverse Effects of Continuous Epidural Sufentanil and Bupivacaine Infusion After Thoracotomy , 1996, Anesthesia and analgesia.

[11]  R. Etches,et al.  Patient-Controlled Epidural Analgesia After Thoracotomy: A Comparison of Meperidine With and Without Bupivacaine , 1996, Anesthesia and analgesia.

[12]  Spencer S. Liu,et al.  Effects of Epidural Bupivacaine After Thoracotomy , 1994, Regional Anesthesia & Pain Medicine.

[13]  F. Burgess,et al.  Thoracic epidural analgesia with bupivacaine and fentanyl for postoperative thoracotomy pain. , 1994, Journal of cardiothoracic and vascular anesthesia.

[14]  A. Montes,et al.  [Comparison between fentanyl and a fentanyl-bupivacaine combination using epidural PCA for postoperative analgesia after thoracotomy]. , 1994, Revista espanola de anestesiologia y reanimacion.

[15]  R. Miguel,et al.  Pain management and spirometry following thoracotomy: a prospective, randomized study of four techniques. , 1993, Journal of cardiothoracic and vascular anesthesia.

[16]  O. Vuolteenaho,et al.  Epidural Versus Intravenous Fentanyl for Reducing Hormonal, Metabolic, and Physiologic Responses after Thoracotomy , 1993, Anesthesiology.

[17]  E. James,et al.  Epidural analgesia for post-thoracotomy patients. , 1982, The Journal of thoracic and cardiovascular surgery.

[18]  K. Peter,et al.  [Continuous peridural analgesia vs patient - controlled intravenous analgesia for pain therapy after thoracotomy]. , 2000, Der Anaesthesist.