[Respiratory and hemodynamic effects of thoracic or lumbar epidural alfentanyl after thoracic surgery].
OBJECTIVE
The aim of this study was to evaluate the effects on pulmonary function and hemodynamics of three different types of analgesia after thoracotomy.


METHODS
Forty-five ASA II-IV patients undergoing thoracotomy (for lobectomy or pneumonectomy) were randomized to three groups (n = 15 each) for double-blind study. After a test dose into the epidural space at T5-7 (groups T-A and T-AL) or L2-3 (group L-A) interspace, 10 micrograms/Kg of alfentanil was administered in all groups, followed by epidural infusion of 400 micrograms/h of alfentanil (group T-A and L-A) or 400 micrograms/h of alfentanil with 50 mg/h of lidocaine (group T-AL) during surgery and 24 hours postoperatively. The patients also used a patient-controlled analgesia device to administer intravenous morphine postoperatively. During the study period the following variables were recorded: hemodynamic parameters, lung function, quality of analgesia and respiratory complications. ANOVA was performed and Scheffé and Chi-square tests were applied with 0.05 as the level of statistical significance.


RESULTS
No differences were found between groups with respect to patient characteristics or type of surgery. Rescue analgesia requirements were higher in group L-A than in the other groups. PaO2 (6 and 18 hours) and spirometric parameters (12 and 18 hours) were significantly higher in group T-AL than in the other groups (p < or = 0.05). No other statistically significant differences were found.


CONCLUSIONS
Respiratory parameters were better after thoracic epidural analgesia with alfentanil and lidocaine than after the other analgesic techniques studied. Group L-A patients had greater need for rescue analgesia than did patients in the other groups.
Granell Gil
M
M
Servicio de Anestesiología, Reanimación y Terapia del Dolor, Servicio de Cirugía Torácica, Hospital General Universitario de Valencia, Avda. Tres Creus, s/n, 46014 València. manuelgranell@teleline.es
Arnau Obrer
A
A
Tovar
O
O
Cantó Armengod
A
A
Palanca Sanfrancisco
J M
JM
D000368:Aged; D015760:Alfentanil / Q000008:administration & dosage / Q000494:pharmacology*; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000494:pharmacology; D010100:Oxygen / Q000097:blood; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D010313:Partial Pressure; D011013:Pneumonectomy / Q000379:methods; D011183:Postoperative Complications; D011446:Prospective Studies; D012119:Respiration / Q000187:drug effects*; D013904:Thoracic Vertebrae
D015760:Alfentanil; D009020:Morphine; D010100:Oxygen