Gastric emptying in post-thoracotomy patients receiving a thoracic fentanyl-bupivacaine epidural infusion.
OBJECTIVE
The effect of anaesthesia and surgery on gastric emptying is not constant, and this has not been previously studied in patients undergoing thoracotomy for lung resection with a bupivacaine-fentanyl epidural infusion for analgesia. There are important implications in this group of patients with regards to the recommencement of important oral medication as well as the risks of aspiration of gastric contents. The study examined gastric emptying in these patients until the second postoperative day.


METHODS
In a prospective repeated measures study, the effect of fentanyl-bupivacaine epidural analgesia at the mid-thoracic level on gastric emptying was assessed in 11 patients undergoing thoracotomy for lung resection. Gastric emptying was measured using a paracetamol absorption technique. Patients acted as their preoperative controls and were assessed 4 h postoperatively and on the second postoperative day.


RESULTS
The mean (SEM) maximum plasma paracetamol concentration was 204.6 (20.4) micromol L(-1) before operation, 61 (9.5) micromol L(-1) 4 h postoperatively and 114.3 (22.6) micromol L(-1) on the second postoperative day. Mean (SEM) paracetamol absorption at 120 min was 15,638 (1441) micromol min L(-1) preoperatively, 5731 (821) micromol min L(-1) 4 h postoperatively and 9325 (1759) micromol min L(-1) on the second postoperative day. Postoperative values were significantly (P < 0.005) less than the preoperative values.


CONCLUSIONS
After thoracotomy, gastric emptying was delayed until at least the second postoperative day in patients receiving mid-thoracic fentanyl-bupivacaine epidural analgesia.
Guha
A
A
University Hospital Aintree, Department of Anaesthesia, Liverpool, UK. arpan1@bigfoot.com
Scawn
N D A
ND
Rogers
S A
SA
Pennefather
S H
SH
Russell
G N
GN
D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural; D019162:Anesthetics, Combined / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000494:pharmacology*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000494:pharmacology*; D002045:Bupivacaine / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000494:pharmacology*; D005746:Gastric Emptying / Q000187:drug effects*; D006801:Humans; D008171:Lung Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D013908:Thoracotomy
D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine