Pain outcomes after thoracotomy: lumbar epidural hydromorphone versus intrapleural bupivacaine.
OBJECTIVE
To evaluate postthoractomy analgesia in patients receiving lumbar epidural hydromorphone versus intrapleural bupivacaine.


METHODS
A randomized, prospective, double-blind study.


METHODS
A university-affiliated medical center.


METHODS
Twenty patients undergoing lateral thoracotomy for either pulmonary wedge resection, lobectomy, or pneumonectomy.


METHODS
Nine patients received epidural hydromorphone, and 11 patients received intrapleural bupivacaine in the postoperative period.


RESULTS
Severity of pain was assessed using a visual analog pain scale (VAPS) (0 to 100 mm) at 1, 3, and 5 hours. Patients receiving epidural hydromorphone had a statistically significant improvement in VAPS scores. Patients who received intrapleural bupivacaine did not achieve a significant reduction in pain scores. Nine of 11 patients in the intrapleural bupivacaine group had "failed" postoperative analgesia as defined by a VAPS greater than 30. Only 3 of 9 patients in the continuous epidural hydromorphone group had "failed" analgesia.


CONCLUSIONS
Epidural hydromorphone is superior to intrapleural bupivacaine in achieving satisfactory pain outcomes during the first 5 hours after thoracotomy.
Department of Anesthesiology, Stanford University School of Medicine, Palo Alto, CA 94305-5115, USA.
R R
RR
Gaeta
A
A
Macario
J B
JB
Brodsky
J G
JG
Brock-Utne
J B
JB
Mark
D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D004091:Hydromorphone / Q000008:administration & dosage*; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000503:physiopathology; D011446:Prospective Studies; D013908:Thoracotomy; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D004091:Hydromorphone; D002045:Bupivacaine