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

Abstract

BackgroundWe aimed to compare patient-controlled thoracic or lumbar epidural analgesia methods after thoracotomy operations.MethodsOne hundred and twenty patients were prospectively randomized to receive either thoracic epidural analgesia (TEA group) or lumbar epidural analgesia (LEA group). In both groups, epidural catheters were administered. Hemodynamic measurements, visual analog scale scores at rest (VAS-R) and after coughing (VAS-C), analgesic consumption, and side effects were compared at 0, 2, 4, 8, 16, and 24 hours postoperatively.ResultsThe VAS-R and VAS-C values were lower in the TEA group in comparison to the LEA group at 2, 4, 8, and 16 hours after surgery (for VAS-R, P = 0.001, P = 0.01, P = 0.008, and P = 0.029, respectively; and for VAS-C, P = 0.035, P = 0.023, P = 0.002, and P = 0.037, respectively). Total 24-hour analgesic consumption was different between groups (175 +/- 20 mL versus 185 +/- 31 mL; P = 0.034). The comparison of postoperative complications revealed that the incidence of hypotension (21/57, 36.8% versus 8/63, 12.7%; P = 0.002), bradycardia (9/57, 15.8% versus 2/63, 3.2%; P = 0.017), atelectasis (1/57, 1.8% versus 7/63, 11.1%; P = 0.04), and the need for intensive care unit (ICU) treatment (0/57, 0% versus 5/63, 7.9%; P = 0.03) were lower in the TEA group in comparison to the LEA group.ConclusionsTEA has beneficial hemostatic effects in comparison to LEA after thoracotomies along with more satisfactory pain relief profile.

Post-Operative Thoracic Epidural Analgesia and Incidence of Major Complications according to Specific Safety Standardized Documentation: A Large Retrospective Dual Center Experience

“…These results are in line with other studies, where no significant complications were observed with the exception of hypotension [17]. Another report demonstrated that complications such as hypotension, bradycardia, atelectasis, and need for ICU were observed but at a lower frequency in thoracic epidural analgesia compared to lumbar epidural analgesia [24]. A review of lung cancer surgical patients suggested that complications did occur following epidural analgesia, but there were no significant differences when comparing epidural with subpleural analgesia [25].…”

Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations — Part II

“…Some consideration must be made to the impact on early ERAS goals and how they will be achieved, and expert post-operative input may be required to ensure reliable analgesia. Although epidurals sited in the lumbar spine have an evidence base for analgesic benefit in gynecologic surgery, thoracic epidurals are preferred: epidurals should be sited at the level appropriate for innervation of the surgical area, and thoracic epidurals are likely to cause less hypotension [ 67 ] and motor block [ 68 ] than those in the lumbar segments.…”

Ultrasound guided erector spinae plane block versus thoracic epidural analgesia in traumatic flail chest, a prospective randomized trial

“…[ 21 ] EA-induced hypotension was reported in the patients with multiple fracture ribs by Sagiroglu et al . [ 31 ] and Peek et al . [ 32 ] ESPB is considered a simpler, safer, and less invasive regional analgesic technique that provides extensive truncal analgesia with smaller risk of pneumothorax or neurovascular injury as there are no vital structures near the site of needle insertion.…”