title: Post-thoracotomy pain relief with subpleural analgesia or thoracic epidural analgesia: randomized clinical trial.
abstract: OBJECTIVE
  Post-thoracotomy pain is a severe and intense pain caused by trauma to ribs, muscles and peripheral nerves. The current study aimed to compare subpleural analgesia (SPA) with thoracic epidural analgesia (TEA) in patients undergoing thoracotomy.
  
  
  METHODS
  Randomized study at Ankara Numune Education and Research Hospital, in Turkey.
  
  
  METHODS
  Thirty patients presenting American Society of Anesthesiologists physical status I-III were scheduled for elective diagnostic thoracotomy. The patients were randomized to receive either patient-controlled SPA or patient-controlled TEA for post-thoracotomy pain control over a 24-hour period. The two groups received a mixture of 3 µg/ml fentanyl along with 0.05% bupivacaine solution through a patient-controlled analgesia pump. Rescue analgesia was administered intravenously, consisting of 100 mg tramadol in both groups. A visual analogue scale was used to assess pain at rest and during coughing over the course of 24 hours postoperatively.
  
  
  RESULTS
  In the SPA group, all the patients required rescue analgesia, and five patients (33%) required rescue analgesia in the TEA group (P < 0.05). Patients who received subpleural analgesia exhibited higher visual analogue scores at rest and on coughing than patients who received thoracic epidural analgesia. None of the patients had any side-effects postoperatively, such as hypotension or respiratory depression.
  
  
  CONCLUSIONS
  Thoracic epidural analgesia is superior to subpleural analgesia for relieving post-thoracotomy pain. We suggest that studies on effective drug dosages for providing subpleural analgesia are necessary.
authors.affiliation: Anesthesiology and Reanimation Department, Ankara Numune Education and Research Hospital, Ankara, Turkey.
authors.forename: Aysu Hayriye
authors.initials: AH
authors.lastname: Tezcan
authors.affiliation: Thoracic Surgery Department, Ankara Numune Education and Research Hospital, Ankara, Turkey.
authors.forename: Özgür
authors.initials: Ö
authors.lastname: Karakurt
authors.affiliation: Thoracic Surgery Department, Ankara Numune Education and Research Hospital, Ankara, Turkey.
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Eryazgan
authors.affiliation: Anesthesiology and Reanimation Department, Ankara Numune Education and Research Hospital, Ankara, Turkey.
authors.forename: Semih
authors.initials: S
authors.lastname: Başkan
authors.affiliation: Anesthesiology and Reanimation Department, Ankara Numune Education and Research Hospital, Ankara, Turkey.
authors.forename: Dilşen Hatice
authors.initials: DH
authors.lastname: Örnek
authors.affiliation: Anesthesiology and Reanimation Department, Ankara Numune Education and Research Hospital, Ankara, Turkey.
authors.forename: Ramazan
authors.initials: R
authors.lastname: Baldemir
authors.affiliation: Thoracic Surgery Department, Ankara Numune Education and Research Hospital, Ankara, Turkey.
authors.forename: Bülent
authors.initials: B
authors.lastname: Koçer
authors.affiliation: Head of Department, Anesthesiology and Reanimation Department, Ankara Numune Education and Research Hospital, Ankara, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Baydar
mesh_terms: D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D003371:Cough / Q000150:complications; D004338:Drug Combinations; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D055770:Interpleural Analgesia / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D013908:Thoracotomy / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D004338:Drug Combinations; D005283:Fentanyl; D002045:Bupivacaine