Comparison of epidural analgesia and cryoanalgesia in thoracic surgery.
A prospective study was carried out in 120 patients undergoing elective thoracotomy for parenchymal disease. Patients were randomized into three groups: A (control group), B (epidural analgesia), C (freezing of intercostal nerves). Subjective pain relief was assessed on a linear visual analog scale. Analgesic requirements were evaluated during the 12 days following surgery, or until discharge if earlier. The vital capacity (VC) and forced expiratory volume in 1 s (FEV1) were measured on the day before operation and on the 1st, 2nd, 3rd and 7th postoperative days (POD). Subjective pain relief was significantly better in Group B in comparison with Group A (P < 0.05) or C (P < 0.05). Group C had the lowest score on the 11th and 12th POD but differences were not statistically significant. Requirements for intravenous analgesics were lower in Group B than in the control group (P < 0.05) during the first 3 POD, and in group C than in the control group the day of operation (P < 0.05). Oral analgesic requirements, when compared with controls, were lower in group B during the first 5 POD, and lower in group C on the 3rd and the 4th POD (P < 0.05). Cryoanalgesia led to a slight but not significant increase in VC and FEV1. Epidural analgesia led to a significant increase when compared with controls in FEV1 during the first 3 POD, and in FVC on the 7th POD (P < 0.05). It is concluded that epidural analgesia led to the best pain relief and restoration of pulmonary function after thoracotomy.(ABSTRACT TRUNCATED AT 250 WORDS)
Brichon
P Y
PY
Department of Thoracic Surgery, Hôpital A. Michallon, La Tronche, France.
Pison
C
C
Chaffanjon
P
P
Fayot
P
P
Buchberger
M
M
Néron
L
L
Bocca
A
A
Verdier
J
J
Sarrazin
R
R
D015360:Analgesia, Epidural / Q000379:methods*; D017558:Elective Surgical Procedures; D005541:Forced Expiratory Volume; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007367:Intercostal Nerves; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000628:therapy*; D011446:Prospective Studies; D012129:Respiratory Function Tests; D013908:Thoracotomy; D014797:Vital Capacity