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Pain relief after esophagectomy: Thoracic epidural analgesia is better than parenteral opioids.
J Cardiothorac Vasc Anesth. 2001 Jun; 15(3):282-7.JC

Abstract

OBJECTIVE

To compare postoperative pain relief and pulmonary function in patients after thoracoabdominal esophagectomy treated by continuing perioperative thoracic epidural anesthesia or changing to parenteral opioids.

DESIGN

Prospective, randomized study.

SETTING

University teaching hospital.

PARTICIPANTS

Thirty-three patients undergoing thoracoabdominal esophagectomy.

INTERVENTIONS

General anesthesia was combined with thoracic epidural anesthesia during surgery. The patients either continued with thoracic epidural analgesia (n = 18) or were switched to patient-controlled analgesia with intravenous morphine (n = 15) for 5 postoperative days. Pain scores were estimated twice daily, at rest and after mobilization. Peak expiratory flow, forced expiratory volume, and vital capacity were measured the day before surgery, postoperative day 2, and postoperative day 6. Adverse events and complications were recorded.

MEASUREMENTS AND MAIN RESULTS

At rest, there were no differences in pain relief between the groups. Pain scores at mobilization showed a significantly lower value in the epidural group (p < 0.027). No intergroup differences were found regarding pulmonary function, which decreased on postoperative day 2, but was improved on postoperative day 6.

CONCLUSION

Continuation of intraoperative thoracic epidural anesthesia for 5 postoperative days provides better pain relief at mobilization compared with a switch to patient-controlled analgesia with intravenous morphine. There was no intergroup difference in the impact on measures of pulmonary function.

Links

Publisher Full Text

Authors+Show Affiliations

Flisberg P
Departments of Anesthesiology and Intensive Care and Surgery, Lund University Hospital, Lund, Sweden.
Törnebrandt K
No affiliation info available
Walther B
No affiliation info available
Lundberg J
No affiliation info available

MeSH

AdultAgedAged, 80 and overAnalgesia, EpiduralAnalgesia, Patient-ControlledAnalgesics, OpioidAnesthesia, GeneralEsophagectomyFemaleHumansInjections, IntravenousMaleMiddle AgedMorphinePain MeasurementPain, PostoperativeProspective Studies

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11426356

Citation

Flisberg, P, et al. "Pain Relief After Esophagectomy: Thoracic Epidural Analgesia Is Better Than Parenteral Opioids." Journal of Cardiothoracic and Vascular Anesthesia, vol. 15, no. 3, 2001, pp. 282-7.
Flisberg P, Törnebrandt K, Walther B, et al. Pain relief after esophagectomy: Thoracic epidural analgesia is better than parenteral opioids. J Cardiothorac Vasc Anesth. 2001;15(3):282-7.
Flisberg, P., Törnebrandt, K., Walther, B., & Lundberg, J. (2001). Pain relief after esophagectomy: Thoracic epidural analgesia is better than parenteral opioids. Journal of Cardiothoracic and Vascular Anesthesia, 15(3), 282-7.
Flisberg P, et al. Pain Relief After Esophagectomy: Thoracic Epidural Analgesia Is Better Than Parenteral Opioids. J Cardiothorac Vasc Anesth. 2001;15(3):282-7. PubMed PMID: 11426356.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pain relief after esophagectomy: Thoracic epidural analgesia is better than parenteral opioids. AU - Flisberg,P, AU - Törnebrandt,K, AU - Walther,B, AU - Lundberg,J, PY - 2001/6/27/pubmed PY - 2001/8/17/medline PY - 2001/6/27/entrez SP - 282 EP - 7 JF - Journal of cardiothoracic and vascular anesthesia JO - J Cardiothorac Vasc Anesth VL - 15 IS - 3 N2 - OBJECTIVE: To compare postoperative pain relief and pulmonary function in patients after thoracoabdominal esophagectomy treated by continuing perioperative thoracic epidural anesthesia or changing to parenteral opioids. DESIGN: Prospective, randomized study. SETTING: University teaching hospital. PARTICIPANTS: Thirty-three patients undergoing thoracoabdominal esophagectomy. INTERVENTIONS: General anesthesia was combined with thoracic epidural anesthesia during surgery. The patients either continued with thoracic epidural analgesia (n = 18) or were switched to patient-controlled analgesia with intravenous morphine (n = 15) for 5 postoperative days. Pain scores were estimated twice daily, at rest and after mobilization. Peak expiratory flow, forced expiratory volume, and vital capacity were measured the day before surgery, postoperative day 2, and postoperative day 6. Adverse events and complications were recorded. MEASUREMENTS AND MAIN RESULTS: At rest, there were no differences in pain relief between the groups. Pain scores at mobilization showed a significantly lower value in the epidural group (p < 0.027). No intergroup differences were found regarding pulmonary function, which decreased on postoperative day 2, but was improved on postoperative day 6. CONCLUSION: Continuation of intraoperative thoracic epidural anesthesia for 5 postoperative days provides better pain relief at mobilization compared with a switch to patient-controlled analgesia with intravenous morphine. There was no intergroup difference in the impact on measures of pulmonary function. SN - 1053-0770 UR - https://www.unboundmedicine.com/medline/citation/11426356/Pain_relief_after_esophagectomy:_Thoracic_epidural_analgesia_is_better_than_parenteral_opioids_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1053-0770(01)26417-9 DB - PRIME DP - Unbound Medicine ER -