Long-term pain and activity during recovery from major thoracotomy using thoracic epidural analgesia.
BACKGROUND
Pain following thoracotomy can persist for years with an undetermined impact on quality of life. Factors hypothesized to modulate this painful experience include analgesic regimen, gender, and type of incision.


METHODS
A total of 157 generally healthy patients of both genders scheduled for segmentectomy, lobectomy, or bilobectomy through a posterolateral or muscle-sparing incision were randomly assigned to receive thoracic epidural analgesia initiated prior to incision or at the time of rib approximation. Pain and activity scores were obtained 4, 8, 12, 24, 36, and 48 weeks after surgery.


RESULTS
Overall, there were no differences in pain scores between the control and intervention groups during hospitalization (P >or= 0.165) or after discharge (P>or= 0.098). The number of patients reporting pain 1 yr following surgery (18 of 85; 21.2%) was not significantly different (P = 0.122) from the number reporting preoperative pain (15 of 120; 12.5%). During hospitalization, women reported greater pain than men (worst pain, P= 0.007; average pain, P= 0.016). Women experienced fewer supraventricular tachydysrhythmias (P = 0.013) and were thus discharged earlier (P = 0.002). After discharge women continued to report greater discomfort than men (P <or= 0.016), but did not differ from men in their level of physical activity (P = 0.241).


CONCLUSIONS
Initiation of thoracic epidural analgesia prior to incision or the use of a muscle-sparing incision did not significantly impact pain or physical activity. Although women reported significantly greater pain during hospitalization and after discharge, they experienced fewer complications, were more likely to be discharged from the hospital sooner, and were just as active after discharge as men.
Ochroch
E Andrew
EA
Department of Anesthesia, University of Pennsylvania Medical Center, Philadelphia, USA.
Gottschalk
Allan
A
Augostides
John
J
Carson
Kathryn A
KA
Kent
Laura
L
Malayaman
Nini
N
Kaiser
Larry R
LR
Aukburg
Stanley J
SJ
D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy* / Q000503:physiopathology; D010351:Patient Discharge; D012737:Sex Factors; D013908:Thoracotomy