A Comparison of Patient Controlled Epidural Analgesia with Sufentanil by the Lumbar Versus Thoracic Route After Thoracotomy

Abstract

To compare the efficacy of patient-controlled lumbar and thoracic epidural sufentanil, 22 patients scheduled for elective thoracotomy were assigned randomly to receive sufentanil via either a lumbar or a thoracic epidural catheter. For 24 h postoperatively, the patients received analgesia only by patient-controlled epidural sufentanil. There were no significant differences in the visual analog scale (VAS) for pain between the two groups at 8 and 24 h postoperatively. Nausea and pruritus were minimum, requiring treatment less than once per 24-h period in either group. The forced vital capacity (FVC) measured at 24 h (as a percentage of baseline FVC) showed no significant difference between the lumbar and thoracic groups (44.7 +/- 3.8 and 41.7 +/- 5.5; P = 0.68). The total sufentanil used by the lumbar and thoracic groups was not significantly different (196 +/- 25.2 micrograms and 157 +/- 28.6 micrograms; P = 0.32). We conclude that there is no clinical advantage of thoracic over lumbar epidural sufentanil in the thoracotomy patient with respect to quality of analgesia, amount of sufentanil used, severity of side effects, or postoperative pulmonary function.

A comparison of thoracic or lumbar patient-controlled epidural analgesia methods after thoracic surgery

“…In the early postoperative period, the use of a PCEA through either a lumber or thoracic epidural catheter has been shown to decrease the risk of myocardial ischemia, improve lung ventilation and decrease incidences of atelectasis and pneumonia [2,3,7]. In our study, a major finding is that the incidence of hypotension and bradycardia were significantly lower in the TEA group in comparison to the LEA group.…”

“…The use of the TEA method was reported as a superior method in comparison to LEA due to better pain control and diminished incidence of postoperative complications [2-4,7]. TEA reduces cardiac and splanchnic sympathetic activity and thereby influences perioperative function of vital organ systems.…”

Study of Respiratory Muscle Strength, Vital Capacity, and Ventilometry in the Postoperative Period of Spinal Surgery by Posterior Access

“…[17][18][19] Some limitations were encountered during the course of this study. However, all patients included in this study were medicated with analgesic in the pre and postoperative periods, which allowed us to think that pain may not be the main factor responsible for the decrease of respiratory variables.…”

Spinal Opioid Bioavailability in Postoperative Pain

“…Clinical trials have demonstrated that hydrophilic opioids like morphine, 9,10 especially when given as a continuous infusion plus LA, 23,43 or by extended-release epidural injections, [44][45][46] provide good postoperative analgesia but are associated with a relatively high rate of adverse effects. 47 Most of the analgesic effect of epidural lipophilic opioids such as fentanyl, [48][49][50][51][52] sufentanil, [53][54][55][56] and alfentanil [57][58][59] is due to systemic uptake. When given alone, the epidural route does not seem to offer advantages over parenteral administration.…”

“…and in most situations, do not outweigh the risks associated with this route. 49,52,54,55,60 Nevertheless, combining them with LA does enhance the analgesic effect, while reducing both the side effects and the doses required, compared with administering the drugs separately. 9,10,23 Fentanyl only seems to reach high enough concentrations at the biophase to produce segmental spinal analgesia when given as an epidural bolus.…”