[Comparison between fentanyl and a fentanyl-bupivacaine combination using epidural PCA for postoperative analgesia after thoracotomy].
OBJECTIVE
The association of opioids and local anesthetics for spinal analgesia appears to have a synergistic++ effect.


OBJECTIVE
To compare the efficacy of fentanyl in comparison with combined fentanyl and bupivacaine at low concentrations in a thoracic epidural system of patient-controlled analgesia (PCA) following thoracotomy.


METHODS
Twenty male patients scheduled for thoracotomy by postero-lateral (T5-T6) incision received analgesia after surgery through a thoracic (T4-T8) epidural catheter connected to a PCA pump (continuous infusion and boluses). They were randomly assigned to 2 groups as follows: group A (n = 10) received a baseline infusion of fentanyl 1 microgram/kg/h and bupivacaine 0.125% with boluses of 12.5 micrograms fentanyl and bupivacaine at 0.125%. The variables studied were: score on a visual analog scale (VAS) before treatment and at 12 and 24 h; the number of boluses administered through the PCA pump, forced vital capacity (FVC) and peak expiratory flow (PEF) before treatment and at 12 h.


RESULTS
Analgesia was satisfactory in both groups, with no significant differences in VAS and number of boluses administered. Nor were there significant differences in lung function tests. One instance of respiratory depression was recorded in group A.


CONCLUSIONS
The analgesic effect obtained with epidural fentanyl or fentanyl/bupivacaine is similar and adequate, and the association of fentanyl and bupivacaine can be considered safe.
Aguilar
J L
JL
Servicio de Anestesiología, Clínica del Dolor, Hospital Universitario de Badalona Germans Trias i Pujol, Universidad Autónoma de Barcelona.
Montes
A
A
Samper
D
D
Roca
G
G
Preciado
M J
MJ
D000368:Aged; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D002045:Bupivacaine / Q000008:administration & dosage*; D004357:Drug Synergism; D005283:Fentanyl / Q000008:administration & dosage* / Q000494:pharmacology; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*; D011013:Pneumonectomy / Q000009:adverse effects; D012119:Respiration / Q000187:drug effects; D013908:Thoracotomy / Q000009:adverse effects*
D005283:Fentanyl; D002045:Bupivacaine
Comparación entre fentanilo y la asociación fentanilo-bupivacaína mediante PCA epidural en la analgesia postoperatoria de la toracotomía.