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Epidural analgesia for pain relief in thoracic surgery.
J Med Assoc Thai. 2000 Apr; 83(4):358-63.JM

Abstract

The effectiveness and adverse effects of continuous epidural analgesia was studied in 104 patients undergoing thoracic operations at Siriraj Hospital. Patients were divided into 3 groups according to the type of surgical approach and the technique of epidural analgesia. Group 1 patients (n = 72) received thoracic epidural block using bupivacaine and morphine combined with light general anesthesia for exploratory thoracotomy; group 2 patients (n = 21) received the identical anesthetic technique, the operation was achieved through median sternotomy; group 3 patients (n = 11) had a similar type of operation to group 1, the anesthetic technique was lumbar epidural block using morphine and combined with light general anesthesia. Continuous epidural morphine infusion was given 0.1-0.4 mg/h during postoperation in all patients for providing adequate pain relief. The results revealed that a 10 cm visual analogue scale (VAS) pain scores were satisfactory and comparable in all groups. Lumbar epidural patients consumed a significantly larger dose of morphine than thoracic epidural groups (P < 0.01). Intraoperative hypotension occurred 43.05 per cent and 19.05 per cent in group 1 and 2, but none was found in group 3 (P < 0.05). Postoperative respiratory depression was found 54.16 per cent in group 1, 33.33 per cent in group 2 and 9.09 per cent in group 3 (P < 0.05), and was mostly mild to moderate, except three patients in group 1 and one in group 2 who needed mechanical ventilatory support. There were no differences among the groups in the incidence of nausea/vomiting and pruritus. It is concluded that both thoracic and lumbar epidural morphine provide excellent postthoracotomy pain relief, whereas, respiratory depression is more common with thoracic than lumbar epidural morphine.

Authors+Show Affiliations

Suwanchinda V
Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Suksompong S
No affiliation info available
Prakanrattana U
No affiliation info available
Udompunthurak S
No affiliation info available

MeSH

AdultAge DistributionAgedAnalgesia, EpiduralAnalgesics, OpioidAnalysis of VarianceChi-Square DistributionDose-Response Relationship, DrugFemaleHumansLumbar VertebraeMaleMiddle AgedMorphinePain MeasurementPain, PostoperativePatient SatisfactionThoracic Surgical ProceduresThoracic Vertebrae

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

10808694

Citation

Suwanchinda, V, et al. "Epidural Analgesia for Pain Relief in Thoracic Surgery." Journal of the Medical Association of Thailand = Chotmaihet Thangphaet, vol. 83, no. 4, 2000, pp. 358-63.
Suwanchinda V, Suksompong S, Prakanrattana U, et al. Epidural analgesia for pain relief in thoracic surgery. J Med Assoc Thai. 2000;83(4):358-63.
Suwanchinda, V., Suksompong, S., Prakanrattana, U., & Udompunthurak, S. (2000). Epidural analgesia for pain relief in thoracic surgery. Journal of the Medical Association of Thailand = Chotmaihet Thangphaet, 83(4), 358-63.
Suwanchinda V, et al. Epidural Analgesia for Pain Relief in Thoracic Surgery. J Med Assoc Thai. 2000;83(4):358-63. PubMed PMID: 10808694.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Epidural analgesia for pain relief in thoracic surgery. AU - Suwanchinda,V, AU - Suksompong,S, AU - Prakanrattana,U, AU - Udompunthurak,S, PY - 2000/5/16/pubmed PY - 2000/6/10/medline PY - 2000/5/16/entrez SP - 358 EP - 63 JF - Journal of the Medical Association of Thailand = Chotmaihet thangphaet JO - J Med Assoc Thai VL - 83 IS - 4 N2 - The effectiveness and adverse effects of continuous epidural analgesia was studied in 104 patients undergoing thoracic operations at Siriraj Hospital. Patients were divided into 3 groups according to the type of surgical approach and the technique of epidural analgesia. Group 1 patients (n = 72) received thoracic epidural block using bupivacaine and morphine combined with light general anesthesia for exploratory thoracotomy; group 2 patients (n = 21) received the identical anesthetic technique, the operation was achieved through median sternotomy; group 3 patients (n = 11) had a similar type of operation to group 1, the anesthetic technique was lumbar epidural block using morphine and combined with light general anesthesia. Continuous epidural morphine infusion was given 0.1-0.4 mg/h during postoperation in all patients for providing adequate pain relief. The results revealed that a 10 cm visual analogue scale (VAS) pain scores were satisfactory and comparable in all groups. Lumbar epidural patients consumed a significantly larger dose of morphine than thoracic epidural groups (P < 0.01). Intraoperative hypotension occurred 43.05 per cent and 19.05 per cent in group 1 and 2, but none was found in group 3 (P < 0.05). Postoperative respiratory depression was found 54.16 per cent in group 1, 33.33 per cent in group 2 and 9.09 per cent in group 3 (P < 0.05), and was mostly mild to moderate, except three patients in group 1 and one in group 2 who needed mechanical ventilatory support. There were no differences among the groups in the incidence of nausea/vomiting and pruritus. It is concluded that both thoracic and lumbar epidural morphine provide excellent postthoracotomy pain relief, whereas, respiratory depression is more common with thoracic than lumbar epidural morphine. SN - 0125-2208 UR - https://www.unboundmedicine.com/medline/citation/10808694/Epidural_analgesia_for_pain_relief_in_thoracic_surgery_ DB - PRIME DP - Unbound Medicine ER -