title: Comparison between repeat bolus intrathecal morphine and an epidurally delivered bupivacaine and fentanyl combination in the management of post-thoracotomy pain with or without cyclooxygenase inhibition.
abstract: OBJECTIVE
  To compare the analgesic efficacy of a traditional epidurally delivered bupivacaine/fentanyl combination with a repeat bolus intrathecal morphine technique in the management of post-thoracotomy pain and to assess further the effect of cyclooxygenase (COX) inhibition on both modalities.
  
  
  METHODS
  Prospective, randomized, blinded study.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  Patients having thoracic surgery.
  
  
  METHODS
  Epidural and intrathecal catheters were inserted. Blood and urine samples were collected for analysis. COX-1 and COX-2 inhibition with ibuprofen and nimesulide (COX-2 selective) was instituted.
  
  
  RESULTS
  Pain was assessed at rest and coughing by visual analog scale. Peak expiratory flow rate, patient satisfaction rating, sedation score, analgesic requirements, and preoperative and postoperative urinary creatinine levels were measured. The spinal and nimesulide combination showed the lowest pain scores (p < 0.001), least reduction in peak expiratory flow rate (p < 0.001), and highest patient satisfaction rating (p = 0.02). COX inhibition did not affect analgesic requirements in the epidural group or increase urinary creatinine in any group.
  
  
  CONCLUSIONS
  The intrathecal morphine and nimesulide combination offered significantly better analgesia than any other combination studied. The efficacious interaction between opioids and nonsteroidal anti-inflammatory drugs may be COX-2 mediated.
authors.affiliation: Department of Anaesthesia, St. James Hospital, Dublin, Ireland.
authors.forename: Connail
authors.initials: C
authors.lastname: McCrory
authors.forename: Dara
authors.initials: D
authors.lastname: Diviney
authors.forename: Jeanne
authors.initials: J
authors.lastname: Moriarty
authors.forename: David
authors.initials: D
authors.lastname: Luke
authors.forename: Desmond
authors.initials: D
authors.lastname: Fitzgerald
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D013908:Thoracotomy
chemical_list: D000701:Analgesics, Opioid; D016861:Cyclooxygenase Inhibitors; D009020:Morphine; D005283:Fentanyl; D002045:Bupivacaine