title: Lung function after lobectomy: a randomized, double-blinded trial comparing thoracic epidural ropivacaine/sufentanil and intravenous morphine for patient-controlled analgesia.
abstract: 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.
authors.affiliation: 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
authors.forename: Christian
authors.initials: C
authors.lastname: Bauer
authors.forename: Jean-Gustave
authors.initials: JG
authors.lastname: Hentz
authors.forename: Xavier
authors.initials: X
authors.lastname: Ducrocq
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meyer
authors.forename: Meyer
authors.initials: M
authors.lastname: Nicolas
authors.forename: Monique
authors.initials: M
authors.lastname: Oswald-Mammosser
authors.forename: Annick
authors.initials: A
authors.lastname: Steib
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Dupeyron
mesh_terms: 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
chemical_list: D000577:Amides; D004338:Drug Combinations; D009020:Morphine; D000077212:Ropivacaine; D017409:Sufentanil