title: [Comparative study of preemptive and postincisional lumbar epidural morphine in pulmonary resection. Preliminary report].
abstract: OBJECTIVE
  To evaluate the efficacy and incidence of side effects of two types of lumbar epidural analgesia with morphine, preemptive or postincisional, combined with total intravenous anesthesia in chest surgery.
  
  
  METHODS
  This double-blind prospective study enrolled 20 patients (ASA I-IV) undergoing lobectomy or pneumonectomy. Anesthetic induction and maintenance was provided with propofol, atracurium and alfentanil. Lumbar epidural analgesia (L2-L3) with morphine was provided for group A patients with 2 to 4 mg upon excision of tissue and for group B with 2 to 4 mg during anesthetic induction. The following variables were recorded: arterial blood gas concentrations, heart rate, SpO2, EtCO2, postanesthetic recovery, arterial gases, side effects and pain on a visual analogue scale. Top-up analgesia was provided by intravenous metamizole and/or epidural morphine. For statistical analysis we used ANOVA, chi-square tests and Student-Newman-Keuls tests.
  
  
  RESULTS
  The need for propofol and alfentanil during anesthesia, and for morphine and metamizole after surgery were statistically greater in group A. Pain 18 hours after surgery was also greater in group A. No significant differences between groups for other variables was observed.
  
  
  CONCLUSIONS
  Preemptive analgesia with lumbar epidural morphine in addition to the general anesthesia described here seems to provide higher-quality analgesia with few side effects, reducing the need for propofol and alfentanil during surgery and for postoperative morphine and metamizole.
authors.affiliation: Servicio de Anestesiología, Hospital General Universitario de Valencia.
authors.forename: M
authors.initials: M
authors.lastname: Granell Gil
authors.forename: R
authors.initials: R
authors.lastname: García Aguado
authors.forename: M
authors.initials: M
authors.lastname: Tommasi Rosso
authors.forename: M D
authors.initials: MD
authors.lastname: López Alarcón
authors.forename: F
authors.initials: F
authors.lastname: Aguar Olba
authors.forename: A
authors.initials: A
authors.lastname: Cantó Armengod
authors.forename: J M
authors.initials: JM
authors.lastname: Palanca Sanfrancisco
authors.forename: F
authors.initials: F
authors.lastname: Grau Real
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000768:Anesthesia, General; D000771:Anesthesia, Intravenous; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008168:Lung / Q000601:surgery*; D008171:Lung Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
vernacular_title: Estudio comparativo entre morfina epidural lumbar preventiva o postincisional en cirugía resectiva pulmonar. Informe preliminar.