Thoracic epidural analgesia in post-thoracotomy patients: comparison of three different concentrations of levobupivacaine and sufentanil

Mendola, C.; Ferrante, Daniela; Oldani, Elena; Cammarota, Gianmaria; Cecci, G; Vaschetto, Rosanna; Corte, Francesco Della

doi:10.1093/bja/aep004

Cited by 29 publications

(44 citation statements)

References 21 publications

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“…1 Previous studies provide substantial support for the use of thoracic epidural infusion of local anesthetics and/or opioids. 2, 3 Management by an inpatient pain service also increases the quality of perioperative analgesia in thoracotomy patients. 4, 5 Unfortunately, severe pain, particularly with cough or movement, is still common.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Gabapentin for Acute Post‐thoracotomy Analgesia: A Randomized, Double‐Blinded, Active Placebo‐Controlled Study

Kinney¹,

Mantilla²,

Carns³

et al. 2011

Pain Practice

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Background The role of preoperative gabapentin in postoperative pain management is not clear, particularly in patients receiving regional blockade. Patients undergoing thoracotomy benefit from epidural analgesia but still may experience significant postoperative pain. We examined the effect of preoperative gabapentin in thoracotomy patients. Methods Adults undergoing elective thoracotomy were enrolled in this prospective, randomized, double-blinded, placebo-controlled study, and randomly assigned to receive 600 mg gabapentin or active placebo (12.5 mg diphenhydramine) orally within 2 hours preoperatively. Standardized management included thoracic epidural infusion, intravenous patient-controlled opioid analgesia, acetaminophen and ketorolac. Pain scores, opioid use and side effects were recorded for 48 hours. Pain was also assessed at 3 months. Results One hundred twenty patients (63 placebo and 57 gabapentin) were studied. Pain scores did not significantly differ at any time point (p=0.53). Parenteral and oral opioid consumption was not significantly different between groups on postoperative day 1 or 2 (p>0.05 in both cases). The frequency of side effects such as nausea and vomiting or respiratory depression was not significantly different between groups, but gabapentin was associated with decreased frequency of pruritus requiring nalbuphine (14% gabapentin vs. 43% control group, p<0.001). The frequency of patients experiencing pain at 3 months post-thoracotomy was also comparable between groups (70% gabapentin vs. 66% placebo group, p=0.72). Conclusions A single preoperative oral dose of gabapentin (600 mg) did not reduce pain scores or opioid consumption following elective thoracotomy, and did not confer any analgesic benefit in the setting of effective multimodal analgesia that included thoracic epidural infusion.

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Section: Introductionmentioning

confidence: 99%

Preoperative Gabapentin for Acute Post‐thoracotomy Analgesia: A Randomized, Double‐Blinded, Active Placebo‐Controlled Study

Kinney¹,

Mantilla²,

Carns³

et al. 2011

Pain Practice

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“…Thus, we chose levobupivacaine and achieved required analgesia. Mendola et al [22] used 10 mg/h levobupivacaine via epidural catheter postoperatively for postthoracotomy pain and stated that this application can provide sufficient analgesia. However, they administered proparacetamol 1.5 gr and ketorolac 60 mg daily to patients.…”

Section: Discussionmentioning

confidence: 99%

The Effectiveness of Preemptive Thoracic Epidural Analgesia in Thoracic Surgery

Ertürk

Kaya

Kutanıs

et al. 2014

BioMed Research International

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Background. The aim of this study is to investigate the effectiveness of preemptive thoracic epidural analgesia (TEA) comparing conventional postoperative epidural analgesia on thoracotomy. Material and Methods. Forty-four patients were randomized in to two groups (preemptive: Group P, control: Group C). Epidural catheter was inserted in all patients preoperatively. In Group P, epidural analgesic solution was administered as a bolus before the surgical incision and was continued until the end of the surgery. Postoperative patient controlled epidural analgesia infusion pumps were prepared for all patients. Respiratory rates (RR) were recorded. Patient's analgesia was evaluated with visual analog scale at rest (VASr) and coughing (VASc). Number of patient's demands from the pump, pump's delivery, and additional analgesic requirement were also recorded. Results. RR in Group C was higher than in Group P at postoperative 1st and 2nd hours. Both VASr and VASc scores in Group P were lower than in Group C at postoperative 1st, 2nd, and 4th hours. Patient's demand and pump's delivery count for bolus dose in Group P were lower than in Group C in all measurement times. Total analgesic requirements on postoperative 1st and 24th hours in Group P were lower than in Group C. Conclusion. We consider that preemptive TEA may offer better analgesia after thoracotomy.

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“…The reason for this is that the combination of 0.125% bupivacaine together with fentanyl (3 mg/ml) or sufentanil (1 mg/ml) provides sufficient pain relief without significant side effects [20][21][22].…”

Section: Discussionmentioning

confidence: 99%

Anaesthesiology and intensive care Comparison of continuous use of thoracic epidural analgesia and intercostal block for pain management after thoracotomy

Sagiroglu¹,

Baysal²,

Kiraz³

et al. 2013

kitp

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StreszczenieCel pracy: Celem pracy było porównanie skuteczności ciągłe-go stosowania znieczulenia zewnątrzoponowego piersiowego oraz blokady międzyżebrowej do leczenia bólu po torakotomii. Materiał i metody: Sześćdziesięciu chorych ukończyło prospektywne badanie z randomizacją przeprowadzone metodą podwójnie ślepej próby. Pacjentów losowo przydzielono do grupy otrzymującej piersiowe znieczulenie zewnątrzoponowe (grupa 1., n = 30) lub blokadę międzyżebrową (grupa 2., n = 30) przez 24 godziny. W obu grupach podawano bupiwakainę o stężeniu 0,25% w ilości 5 ml/godzinę przy użyciu cewnika. W celu oceny bólu użyto wizualnej skali analogowej w spoczynku (VAS-R) i po kaszlu (VAS-C). Wyniki pobrano na począt-ku badania, jak również 1, 6 i 24 godziny po zabiegu. Zebrano także dane dotyczące zużycia morfiny, powikłań i efektów niepożądanych. Wyniki: Wartości VAS-R i VAS-C na początku były podobne, jednak wyniki uzyskane po upływie 1, 6 i 24 godzin były znacząco niższe w grupie 1. niż w grupie 2. (odpowiednio p = 0,017, p = 0,001, p = 0,023 dla VAS-R oraz p = 0,006, p = 0,002, p = 0,032 dla VAS-C). Zużycie morfiny na 24 godziny w grupie 1. było niższe w porównaniu z grupą 2. (p = 0,032). W grupie 1 u 5 z 30 pacjentów (17%) wystąpiło niedociśnienie, w grupie 2. nie zanotowano takich przypadków (p = 0,02). Wniosek: W przypadku bólu po torakotomii lepszą kontrolę analgezji uzyskuje się za pomocą znieczulenia zewnątrzopo-nowego piersiowego, jednak blokada międzyżebrowa stanowi alternatywę, ponieważ jest związana z mniejszą częstością występowania niedociśnienia. Słowa kluczowe: ból, torakotomia, znieczulenie zewnątrzopo-nowe piersiowe, blokada nerwu międzyżebrowego. Kardiochirurgia i Torakochirurgia Polska 2013; 10 (3) 244 ANAESTHESIOLOGY AND INTENSIVE CARE AbstractAim of the study: We aimed to compare the efficacy of the continuous use of thoracic epidural and intercostal analgesia for post-thoracotomy pain. Material and methods: Sixty patients completed a prospective, randomized, double-blinded study. The patients were randomized to receive thoracic epidural (group 1, n = 30) or intercostal block (group 2, n = 30) for 24 hours. In both groups, 0.25% bupivacaine was infused at a rate of 5 ml/h through an inserted catheter. Visual analog scale at rest (VAS-R) and after coughing (VAS-C) scores were recorded at baseline and at 1, 6 and 24 hours after surgery to evaluate pain. Morphine consumption, complications and side effects were recorded as well. Results: VAS-R and VAS-C scores were similar at baseline; however, 1 st , 6 th and 24 th hour scores of group 1 were significantly lower than the scores of group 2 (for VAS-R; p = 0.017, p = 0.001, p = 0.023, for VAS-C; p = 0.006, p = 0.002, p = 0.032, respectively). 24-hour morphine consumption was lower in group 1 in comparison to group 2 (p = 0.032). In group 1, 5 out of 30 patients (17%) experienced hypotension, compared with none in group 2 (p = 0.02). Conclusions: For post-thoracotomy pain, better control of analgesia is observed with the thoracic epidural technique; however, i...

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Thoracic epidural analgesia in post-thoracotomy patients: comparison of three different concentrations of levobupivacaine and sufentanil

Abstract: The same dose of a mixture of levobupivacaine and sufentanil administered in three different volumes and concentrations during continuous thoracic epidural infusion for thoracotomy provided an equal incidence of adverse haemodynamic effects, nausea, vomiting, or pruritus.

Cited by 29 publications

References 21 publications

Preoperative Gabapentin for Acute Post‐thoracotomy Analgesia: A Randomized, Double‐Blinded, Active Placebo‐Controlled Study

Preoperative Gabapentin for Acute Post‐thoracotomy Analgesia: A Randomized, Double‐Blinded, Active Placebo‐Controlled Study

The Effectiveness of Preemptive Thoracic Epidural Analgesia in Thoracic Surgery

Anaesthesiology and intensive care Comparison of continuous use of thoracic epidural analgesia and intercostal block for pain management after thoracotomy

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