Post-thoracotomy analgesia--comparison epidural fentanyl to intravenous pethidine.
METHODS
To evaluate the efficacy of postthoracotomy analgesia with intermittent epidural fentanyl. 50 patients were allocated randomly into 2 groups. The first group received intermittent epidural fentanyl and the second group received intermittent intravenous analgesia using pethidine. The variables studied were: pain score; total amount of additional intravenous opioid analgesia, and ventilatory function parameters [forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and FEV1/FVC ratio]:


RESULTS
In the first postoperative day, pain scores were higher in the epidural group (P = 0.034), but there was no significant difference between mean pain scores in the second and third days (P = 0.61, P = 0.15, respectively). On all three days, significantly more additional analgesics were required in the epidural group. A difference was found between both groups in the post- to pre-operative FEV1, FVC and FEV1/FVC ratios, with the better preservation of the ventilatory function in the epidural group (P = 0.001, 0.013, <0.0001, respectively).


CONCLUSIONS
The analgesic effect of intermittent epidural fentanyl is not adequate and postoperative pain relief has not any significant advantage over the more easily-applied intravenous analgesia. However, better preservation of ventilatory function makes epidural fentanyl a useful adjunct analgesia in reduction of post-thoracotomy pulmonary complications.
Movafegh
Ali
A
Department of Anesthesia and Critical Care, Shariati Teaching Hospital, Faculty of Medicine, Tehran, Iran.
Ghafouri
Ali
A
Nasr-Esfahani
Mehran
M
Gholamrezanezhad
Ali
A
Madhkhan
Sepide
S
D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use*; D000767:Anesthesia, Epidural; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008614:Meperidine / Q000627:therapeutic use; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D012129:Respiratory Function Tests; D013908:Thoracotomy; D014797:Vital Capacity / Q000187:drug effects
D000701:Analgesics, Opioid; D008614:Meperidine; D005283:Fentanyl