Anaesthesia
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Randomized Controlled Trial Clinical Trial
Continuous thoracic epidural fentanyl for post-thoracotomy pain relief: with or without bupivacaine?
Twenty-five ASA 1 or 2 patients undergoing thoracotomy were entered into a prospective, randomised, double-blind study comparing thoracic epidural fentanyl alone and thoracic epidural fentanyl combined with 0.2% bupivacaine. Pain relief, pulmonary function and cardiovascular stability were assessed. ⋯ The incidence of side effects attributable to epidural fentanyl was high, but hypotension did not occur. Small doses of bupivacaine administered together with fentanyl into the thoracic epidural space improve analgesia without causing hypotension.
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Pressure recordings were made during passage of a Tuohy needle from the interspinous ligament to the subarachnoid space for lumbar drain insertion. Epidural space pressures were always positive. ⋯ Use of a closed measurement system such as this facilitates the development of large transdural pressure gradients because of the inability of the epidural space pressure to equilibrate with atmospheric pressure. This may contribute to ease of dural puncture.