[Influence of the analgesic strategy on the respiratory function after thoracic surgery for lobectomy].
OBJECTIVE
To compare the influence of thoracic epidural analgesia (TEA) with intravenous patient-controlled analgesia with morphine (PCA) on the early postoperative respiratory function after lobectomy.


METHODS
Prospective and comparative observational study.


METHODS
Fourty-four patients scheduled for lobectomy (n=22 per group) were studied on the evolution of the postoperative respiratory function assessed by the forced vital capacity (FVC) and the forced expired volume (FEV(1)) during the first two postoperative days and the analysis of noctural arterial desaturation during the three first postoperative nights.


RESULTS
The use of TEA resulted in fewer decrease both in FEV(1) (1.01+/-0.34 versus 1.31+/-0.51 l/s for Day 1, P=0.03; 1.13+/-0.37 versus 1.53+/-0.59 l/s for Day 2, P=0.01) and in FVC (1.23 [1.05-1.51] versus 1.57 [1.38-2.53] l for day 1, P=0.008; 1.33+/-0.43 versus 2.24+/-0.87 l for day 2, P<0.001). Moreover, the duration of arterial desaturation<90% were longer in the PCA group during the first (8.6 [0.8-28.2] versus 1.3 [0-2.6] min, P=0.02) and the second postoperative night (13.5 [3.5-54] versus 0.4 [0-2.6] min, P=0.025).


CONCLUSIONS
The results of this study suggest that the use of TEA is associated with a better preservation of respiratory function assessed by spirometric data and noctural arterial desaturation recording after thoracic surgery for lobectomy.
Michelet
P
P
Département d'anesthésie-réanimation, hôpital Sainte-Marguerite, boulevard Sainte-Marguerite, 13009 Marseille, France. pierre.michelet@ap-hm.fr
Hélaine
A
A
Avaro
J-P
JP
Guervilly
C
C
Gaillat
F
F
Kerbaul
F
F
Thomas
P
P
Auffray
J-P
JP
D000368:Aged; D016058:Analgesia, Patient-Controlled; D000767:Anesthesia, Epidural; D005260:Female; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D009294:Narcotics / Q000008:administration & dosage; D011013:Pneumonectomy; D012129:Respiratory Function Tests
D009294:Narcotics; D009020:Morphine