Lung function after lobectomy: a randomized, double-blinded trial comparing thoracic epidural ropivacaine/sufentanil and intravenous morphine for patient-controlled analgesia.
BACKGROUND
Although thoracic epidural analgesia (TEA) is considered superior to IV opioids for postoperative analgesia after thoracic surgery, a few studies clearly demonstrate an improvement in pulmonary function attributable to TEA using a local anesthetic in combination with an opioid.


METHODS
In this prospective, randomized, double-blind study, we compared the effects of TEA with ropivacaine and sufentanil (TEA group) to IV morphine (IV group), as they affected pain and pulmonary function after lobectomy in 68 patients. Pain intensity, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, forced expiratory flows, and sniff nasal inspiratory pressure as a marker of inspiratory muscle strength were measured from the first to the fourth postoperative day.


RESULTS
Pain relief was better in the TEA group at rest and on coughing (P < 0.001). The impairment of FVC and FEV1 was less in the TEA group when compared with that in the IV group (P < 0.001 and P = 0.003, respectively). Sniff nasal inspiratory pressure, FEV1/FVC ratio, and expiratory flow values decreased similarly in both groups. In-hospital mortality, as well as postoperative pulmonary complications, was not different between groups.


CONCLUSIONS
After lobectomy, TEA enables a significant increase in pulmonary function concomitant with better pain relief than systemic morphine, although a modest intercostal motor block may occur.
Bauer
Christian
C
Department of Anesthesia and Intensive Care, Hopital Cardio-Vasculaire et Pneumologique Louis Pradel, Hospices Civils de Lyon, Lyon-Bron, France. christian.bauer@chu-lyon.fr
Hentz
Jean-Gustave
JG
Ducrocq
Xavier
X
Meyer
Nicolas
N
Nicolas
Meyer
M
Oswald-Mammosser
Monique
M
Steib
Annick
A
Dupeyron
Jean-Pierre
JP
D000368:Aged; D000577:Amides / Q000008:administration & dosage*; D015360:Analgesia, Epidural / Q000379:methods; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010147:Pain Measurement / Q000187:drug effects / Q000379:methods; D011446:Prospective Studies; D012119:Respiration / Q000187:drug effects*; D012129:Respiratory Function Tests / Q000379:methods; D000077212:Ropivacaine; D017409:Sufentanil / Q000008:administration & dosage*; D013908:Thoracotomy
D000577:Amides; D004338:Drug Combinations; D009020:Morphine; D000077212:Ropivacaine; D017409:Sufentanil