title: Optimal concentration of epidural fentanyl in bupivacaine 0.1% after thoracotomy.
abstract: BACKGROUND
  The aim of this prospective, double-blind, randomized controlled trial was to investigate the analgesic and adverse effects of three commonly used concentrations of thoracic epidural fentanyl with bupivacaine in patients undergoing thoracotomy for lung resection.
  
  
  METHODS
  We studied 99 patients who were randomized to receive fentanyl 2 microg ml(-1) (group 2), fentanyl 5 microg ml(-1) (group 5) and fentanyl 10 microg ml(-1) (group 10) in bupivacaine 0.1% via a thoracic epidural. Postoperatively, pain on coughing was assessed using a visual analogue scale (VAS) and an observer verbal rating score (OVRS) at 2, 8, 16 and 24 h. At the same times, sedation, pruritus and nausea were assessed.
  
  
  RESULTS
  Of 29, 28 and 32 patients who completed the study in groups 2, 5 and 10 respectively, there was no significant difference in baseline characteristics between the three groups. The number of patients with episodes of unsatisfactory pain, i.e. VAS scores >30 mm and OVRS >1, at each of the four assessments postoperatively was significantly (P<0.01) higher in group 2 than in groups 5 and 10. In group 10, 16 patients had sedation scores >1 compared with 10 each in groups 2 and 5. In addition, 19 patients in group 10 experienced pruritus compared with 12 each, in groups 2 and 5. These differences were not significant. Nausea was not significantly different between the three groups.
  
  
  CONCLUSIONS
  We conclude that thoracic epidural fentanyl 5 microg ml(-1) with bupivacaine 0.1% provides the optimum balance between pain relief and side effects following thoracotomy.
authors.affiliation: Department of Anaesthesia, The Cardiothoracic Centre, Liverpool, Thomas Drive, Liverpool L14 3PE, UK.
authors.forename: C N H
authors.initials: CN
authors.lastname: Tan
authors.forename: A
authors.initials: A
authors.lastname: Guha
authors.forename: N D A
authors.initials: ND
authors.lastname: Scawn
authors.forename: S H
authors.initials: SH
authors.lastname: Pennefather
authors.forename: G N
authors.initials: GN
authors.lastname: Russell
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D013908:Thoracotomy
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D004338:Drug Combinations; D005283:Fentanyl; D002045:Bupivacaine