Prospective, randomized comparison of extrapleural versus epidural analgesia for postthoracotomy pain.
BACKGROUND
Thoracic epidural analgesia is considered the method of choice for postthoracotomy analgesia, but it is not suitable for every patient and is associated with some risks and side effects. We therefore evaluated the effects of an extrapleural intercostal analgesia as an alternative to thoracic epidural analgesia.


METHODS
In a prospective, randomized study, pain control, recovery of ventilatory function, and pulmonary complications were analyzed in patients undergoing elective lobectomy or bilobectomy. Two groups of 15 patients each were compared: one received a continuous extrapleural intercostal nerve blockade (T3 through T6) with bupivacaine through an indwelling catheter, the other was administered a combination of local anesthetics (bupivacaine) and opioid analgesics (fentanyl) through a thoracic epidural catheter.


RESULTS
Both techniques were safe and highly effective in terms of pain relief and recovery of postoperative pulmonary function. However, minor differences were observed that, together with practical benefits, would favor extrapleural intercostal analgesia.


CONCLUSIONS
These results led us to suggest that extrapleural intercostal analgesia might be a valuable alternative to thoracic epidural analgesia for pain control after thoracotomy and should particularly be considered in patients who do not qualify for thoracic epidural analgesia.
Kaiser
A M
AM
Department of Surgery and Institute for Anesthesiology, University Hospital, Zürich, Switzerland.
Zollinger
A
A
De Lorenzi
D
D
Largiadèr
F
F
Weder
W
W
D000698:Analgesia / Q000379:methods*; D015360:Analgesia, Epidural; D002045:Bupivacaine / Q000008:administration & dosage; D017558:Elective Surgical Procedures; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy*; D011013:Pneumonectomy; D011183:Postoperative Complications; D011446:Prospective Studies; D012119:Respiration; D013908:Thoracotomy
D005283:Fentanyl; D002045:Bupivacaine