Effects of epidural bupivacaine after thoracotomy.
OBJECTIVE
Combinations of bupivacaine and fentanyl are popular for postoperative epidural analgesia. However, there are little data from which to select a rational dose of bupivacaine. The study examined the effects of increasing amounts of epidural bupivacaine on postoperative analgesia, epidural fentanyl consumption, and side effects after thoracotomy.


METHODS
Twenty-four patients were randomized in a double-blind manner to receive intra- and postoperative epidural infusions of either saline, 0.01% bupivacaine, 0.05% bupivacaine, or 0.1% bupivacaine at 10 mL/h. All patients received a standardized combined epidural (120 mg lidocaine and 1.5 micrograms/kg of fentanyl) and general anesthesia. Further postoperative analgesia was provided with fentanyl patient-controlled epidural analgesia (PCEA) only.


RESULTS
There were no differences between groups in visual analog scale (VAS) pain scores at rest or cough, but 10 and 5 mg/h of bupivacaine provided better analgesia during physiotherapy (P < .05). The use of 10 and 5 mg/h of bupivacaine led to significant opioid sparing (50% decrease) when compared to saline and 1 mg/h bupivacaine (P < .03). There was a trend toward a greater incidence of orthostasis with the use of bupivacaine at 10 mg/h (P = .09). Incidences of opioid side effects were not different between groups.


CONCLUSIONS
The results demonstrate improved analgesia with physiotherapy and significant opioid sparing when 10 and 5 mg/h doses of bupivacaine are used. However, the incidence of orthostasis may be increased with the use of 10 mg/h. Thus, 5 mg/h of epidural bupivacaine (.05% at 10 mL/h) improved analgesia, decreased opioid requirements, and did not have detectable hemodynamic effects.
Liu
S
S
Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington 98111, USA.
Angel
J M
JM
Owens
B D
BD
Carpenter
R L
RL
Isabel
L
L
D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003371:Cough / Q000150:complications; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D013908:Thoracotomy
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine