title: Prospective, comparative study of the On-Q® PainBuster® postoperative pain relief system and thoracic epidural analgesia after thoracic surgery.
abstract: OBJECTIVE
  Pain after thoracotomy is associated with intense discomfort leading to impaired pulmonary function.
  
  
  METHODS
  Prospective, non-randomized trial from April 2009 to September 2011.
  
  
  METHODS
  Department of Thoracic Surgery, single-center.
  
  
  METHODS
  Thoracic surgical patients.
  
  
  METHODS
  Comparison of thoracic epidural analgesia (TEA) with the On-Q® PainBuster® system after thoracotomy.
  
  
  RESULTS
  The TEA group (n=30) received TEA with continuous 0.2% ropivacaine at 4 mL-to-8 mL/h, whereas Painbuster® patients (n=32) received 0.75% ropivacaine at 5 mL/h until postoperative day 4 (POD4). Basic and on-demand analgesia were identical in both groups. Pain was measured daily on a numeric analog scale from 0 (no pain) to 10 (worst pain) at rest and at exercise. There were no significant differences regarding demographic and preoperative data between the groups, but PainBuster® patients had a slightly lower relative forced expiratory volume in 1 second (FEV1) (71±20% versus 86±21%; p=0.01). Most common surgical procedures were lobectomies (38.8%) and atypical resections (28.3%) via anterolateral thoracotomy. Most common primary diagnoses were lung cancer (48.3%) and tumor of unknown origin (30%). At POD1, median postoperative pain at rest was 2.1 (1; 2.8) in the TEA group and 2 (1.5; 3.8; p=0.62) in the PainBuster® group. At exercise, median pain was 4.3 (3.5; 3.8) in the TEA group compared to 5.0 (4.0; 6.5; p=0.07). Until POD 5 there were decreases in pain at rest and exercise but without significant differences between the groups.
  
  
  CONCLUSIONS
  Sufficient analgesia after thoracotomy can be achieved with the intercostal PainBuster® system in patients, who cannot receive TEA.
authors.affiliation: Department of Thoracic Surgery, University Medical Center RegensburgRegensburg, Germany. Electronic address: micha.ried@t-online.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Ried
authors.affiliation: Department of Thoracic Surgery, University Medical Center RegensburgRegensburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schilling
authors.affiliation: Department of Thoracic Surgery, University Medical Center RegensburgRegensburg, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Potzger
authors.affiliation: Department of Anesthesiology, University Medical Center RegensburgRegensburg, Germany.
authors.forename: Karl-Peter
authors.initials: KP
authors.lastname: Ittner
authors.affiliation: Department of Anaesthesiology, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rupp
authors.affiliation: Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany.
authors.forename: Tamas
authors.initials: T
authors.lastname: Szöke
authors.affiliation: Department of Thoracic Surgery, University Medical Center RegensburgRegensburg, Germany; Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany.
authors.forename: Hans-Stefan
authors.initials: HS
authors.lastname: Hofmann
authors.affiliation: Department of Thoracic Surgery, University Medical Center RegensburgRegensburg, Germany.
authors.forename: Claudius
authors.initials: C
authors.lastname: Diez
mesh_terms: D000577:Amides; D015360:Analgesia, Epidural / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D010865:Pilot Projects; D011446:Prospective Studies; D012129:Respiratory Function Tests; D000077212:Ropivacaine; D019616:Thoracic Surgical Procedures; D013904:Thoracic Vertebrae; D016896:Treatment Outcome
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D002045:Bupivacaine
keywords: PainBuster(®); postpoerative pain; thoracic epidural analgesia; thoracic surgery; thoracotomy