Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 1993
Randomized Controlled Trial Comparative Study Clinical TrialComparison of thoracic and lumbar epidural infusions of bupivacaine and fentanyl for post-thoracotomy analgesia.
Epidural analgesia, via either a thoracic or lumbar route, is commonly used to provide postoperative analgesia following thoracotomy for pulmonary resection, but little data indicate which location is better in terms of postoperative analgesia, side effects, or associated complications. In this study, 45 patients, who were scheduled to have epidural analgesia and undergo a lateral thoracotomy, were randomized to receive either a thoracic or a lumbar catheter. ⋯ This study found no statistical difference in pain relief or side effects between lumbar and thoracic epidural analgesia for post-thoracotomy pain. An increased infusion rate (6.4 +/- 1.9 v 5.1 +/- 1.4 mL/h, P = 0.02) was required in the lumbar group to achieve equivalent analgesic levels.
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J. Cardiothorac. Vasc. Anesth. · Oct 1993
Randomized Controlled Trial Comparative Study Clinical TrialPain management and spirometry following thoracotomy: a prospective, randomized study of four techniques.
Forty-five patients who underwent anterolateral and posterolateral thoracotomy were studied to compare the relative efficacy of cryoanalgesia, epidural morphine, intrapleural analgesia, and intravenous morphine for relief of postoperative pain and prevention of deterioration in pulmonary function. Spirometry (FEV1, FVC) was performed preoperatively and postoperatively. Patients' pain was assessed using the 0 to 100 mm visual analog scale. ⋯ Although the number of evaluable patients was insufficient to draw definitive conclusions, 12-week follow-up suggested a difference in the incidence of post-thoracotomy pain syndrome in patients who received cryoanalgesia. It is concluded that post-thoracotomy pain is best relieved with epidural morphine, compared to intrapleural analgesia, cryoanalgesia, and parenteral morphine. There was no change in the deterioration in spirometric tests after thoracotomy, nor was there any advantage offered by cryoanalgesia or intrapleural analgesia over intravenous morphine, with respect to pain relief.