A randomized-controlled study of intrathecal versus epidural thoracic analgesia in patients undergoing abdominal cancer surgery.
BACKGROUND
We sought to determine the effectiveness of continuous intrathecal thoracic analgesia (ITA) in comparison with continuous epidural thoracic analgesia (ETA) for the management of postoperative pain after abdominal cancer surgery in a randomised controlled study.


METHODS
Catheters were inserted at T8-10 level for both techniques. Sixty patients were randomized to receive ITA providing levobupivacaine 0.25%, at 0.5-0-7 ml/h, associated with a single bolus of morphine 0.15 mg, or ETA with levobupivacaine 0.25% 4-6 ml/h and a single bolus of epidural morphine 2-3 mg. Data were collected before discharging from recovery room to the surgical ward, 1, 2, 3, 8, 12, 24 h, and 48 h after operation. The primary outcome was pain intensity evaluation. Postoperative morphine consumption, hemodynamics, fluids, and blood losses for the first postoperative 48 h, surgical outcome, hospital stay, and complications were also collected.


RESULTS
Pain intensity at rest mean values ranged from 1.12 to 1.44 and from 1.04 to 1.20 in ITA group and ETA group, respectively. Dynamic pain intensity mean values ranged from 1.28 to 1.70 and from 1.16 to 1.80 in ITA group and ETA group, respectively. No significant differences were found between the two groups. Total amount morphine consumption was minimal in both groups, 4.4 mg (+/-2.9) and 3.1 mg (+/-2.4), for ITA and ETA groups, respectively. There were no severly sedated patients. Hemodynamic variables, diuresis, amounts of fluids, and red cell transfusion were equivalent between the groups. No important technical complications were reported in both groups and postoperative surgical complications were not related to the examined techniques.


CONCLUSIONS
ITA and ETA produced the same levels of analgesia, without relevant complications.
Mercadante
Sebastiano
S
Anesthesia & Intensive Care Unit, Pain Relief & Palliative Care Unit, La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy. terapiadeldolore@la-maddalena.it
Villari
Patrizia
P
Casuccio
Alessandra
A
Marrazzo
Antonio
A
D000008:Abdominal Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007278:Injections, Spinal / Q000379:methods*; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects*; D010149:Postoperative Pain / Q000517:prevention & control*; D016896:Treatment Outcome; D055815:Young Adult
D000779:Anesthetics, Local; D008012:Lidocaine