Cost-effectiveness of thoracic patient-controlled epidural analgesia using bupivacaine with fentanyl vs bupivacaine with morphine after thoracotomy and upper abdominal surgery

Abstract

Objectives: To compare the effectiveness and cost of thoracic patient-controlled epidural analgesia (TPCEA) using bupivacaine with fentanyl (BF) vs bupivacaine with morphine (BM) solution. Material and Method: In a blinded, randomized controlled trial, 90 adult patients who were scheduled for thoracotomy or upper abdominal surgery were enrolled. All patients were anesthetized by a combined general/epidural technique. Intraoperative and postoperative analgesia was provided by TPCEA using bupivacaine 0.0625% with either fentanyl (group BF) or morphine (group BM) solution. The occurrence and severity of side effects, visual analogue scale (VAS) for pain at rest and during movement, patients satisfaction score as well as charged cost of pain and side effect management were recorded for 48 hrs. Results: Demographic data of both groups were not significantly different. No statistical differences were noted with respect to efficacy of pain relief between the 2 groups. Only 28.5% of the patients in group BM required supplemental systemic analgesia within 24 hours after epidural catheter removal compared with 51.4% in the group BF. Patients' satisfaction and the severity of epidural analgesia related side effects, using itching and nausea/vomiting score, of both groups were not significantly different except the median nausea/ vomiting scores of group BM at 18 and 24 hours were statistically higher than those of group BF (P = 0.047 and 0.02, at 18 and 24 hour respectively) but not clinically different. The mean charged cost of medication used in group BM (470.64 ± 160.54 baht) was lower than that in group BF (814.15 ± 217.51 baht). Conclusion: TPCEA using BF and BM solution resulted in similar pain relief and side effect profiles but with higher charged cost of medication in group BF. Morphine appears to be a more cost-effective choice than fentanyl for TPCEA after thoracotomy or upper abdominal surgery.