Epidural bupivacaine, sufentanil or the combination for post‐thoracotomy pain

Abstract

Analgesia with epidural bupivacaine, sufentanil or the combination was studied in 50 patients who had undergone thoracotomy. During operation all patients received an initial dose of bupivacaine 0.5% with adrenaline 5 micrograms.ml-1 (5-10 ml) by thoracic epidural catheter. One hour later the patients were divided into three groups: the bupivacaine group (bupivacaine 0.125%), the sufentanil group (50 micrograms sufentanil in 60 ml normal saline) and the combination group (50 micrograms sufentanil in 60 ml bupivacaine 0.125%). Analgesia in the three groups was provided by a continuous epidural infusion (5-10 ml.h-1) for 3 days. The mean dose of bupivacaine was significantly higher (P less than 0.05) in the bupivacaine group (12.07 mg.h-1 (s.e.mean 0.97 mg.h-1)), compared with the combination group (9.82 mg.h-1 (s.e.mean 0.43 mg.h-1)). The mean dose of sufentanil in the sufentanil group was similar to the combination group (6.37 micrograms.h-1 (s.e.mean 0.23 micrograms.h-1) and 6.52 micrograms.h-1 (s.e.mean 0.28 micrograms.h-1), respectively. The pain scores on the inverse visual analogue scale of most patients in the bupivacaine group were unacceptably low. The sufentanil group had much better pain scores, but on exercise these patients experienced more pain than the combination group. The combination group had, overall, better pain scores. In the combination group, there were better respiratory results.

Thoracic epidural infusions for post thoracotomy pain relief: a clinical study to compare the efficacy of fentanyl — bupivicaine mixtures versus fentanyl alone

“…Interestingly there were no significant between group differences in the incidence of postoperative hypotension. The relative haemodynamic stability when using small concentrations of local anesthetics has been confirmed by other studies 7,17 . There was however a greater need for vasopressor in the bupivicaine group (Group 2 > Group1).…”

Epidural ropivacaine or sufentanil–ropivacaine infusions for post-thoracotomy pain☆

“…It offers maximal sympathetic blockade of the heart and bowel and promotes coronary perfusion and gastrointestinal motility, while providing freedom from lower extremity motor blockade and opioid-induced side effects [9]. Epidural opioids have been combined with epidural local anaesthetics with the aim of synergistically blocking spinal nociceptive pathways while reducing the dose-related adverse effects of either class alone [5,10]. In this study, we used ropivacaine as the local anaesthetic and sufentanil as the opioid.…”

“…Ropivacaine was the local anaesthetic of choice because of more differential block allowing for a better separation between sensory and motor block, low toxicity relative to potency and long duration of action, resulting in a low risk of toxicity during continuous infusion [11]. Sufentanil has a rapid onset and potent analgesic effect due to high lipid solubility, an intermediate degree of ionisation, a low molecular weight, a very high m receptor affinity, and a high therapeutic range [5,12]. The analgesic efficacy of thoracic epidural ropivacaine was clearly enhanced when combined with sufentanil.…”

“…Most of the patients in bupivacaine group had high VAS scores and there were a high number of dropouts from the study due to inadequate analgesia. Combination of local anaesthetics with opioids has been found to provide better pain control especially during exercise and was offered as an optimum analgesic regimen [5].…”

“…Although systemic opioids have traditionally formed the basis for the treatment of post-thoracotomy pain, the continuous epidural administration of analgesics has been shown to provide better pain control [5].…”