Publication: Epidural analgesia for pain relief in thoracic surgery
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Issued Date
2000-12-01
Resource Type
ISSN
01252208
Other identifier(s)
2-s2.0-0034167347
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Mahidol University
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SCOPUS
Bibliographic Citation
Journal of the Medical Association of Thailand. Vol.83, No.4 (2000), 358-363
Suggested Citation
Vorapa Suwanchinda, Suthipol Udompunthurak Epidural analgesia for pain relief in thoracic surgery. Journal of the Medical Association of Thailand. Vol.83, No.4 (2000), 358-363. Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/26047
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Title
Epidural analgesia for pain relief in thoracic surgery
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Abstract
The effectiveness and adverse effects of continuous epidural analgesia was studied in 104 patients undergoing thoracic operations at Siriraj Hospital. Patients were divided into 3 groups according to the type of surgical approach and the technique of epidural analgesia. Group 1 patients (n = 72) received thoracic epidural block using bupivacaine and morphine combined with light general anesthesia for exploratory thoracotomy; group 2 patients (n = 21) received the identical anesthetic technique, the operation was achieved through median sternotomy; group 3 patients (n = 11) had a similar type of operation to group 1, the anesthetic technique was lumbar epidural block using morphine and combined with light general anesthesia. Continuous epidural morphine infusion was given 0.1-0.4 mg/h during postoperation in all patients for providing adequate pain relief. The results revealed that a 10 cm visual analogue scale (VAS) pain scores were satisfactory and comparable in all groups. Lumbar epidural patients consumed a significantly larger dose of morphine than thoracic epidural groups (P <0.01). Intraoperative hypotension occurred 43.05 per cent and 19.05 per cent in group 1 and 2, but none was found in group 3 (P <0.05). Postoperative respiratory depression was found 54.16 per cent in group 1, 33.33 per cent in group 2 and 9.09 per cent in group 3 (P <0.05), and was mostly mild to moderate, except three patients in group 1 and one in group 2 who needed mechanical ventilatory support. There were no differences among the groups in the incidence of nausea/vomiting and pruritus. It is concluded that both thoracic and lumbar epidural morphine provide excellent postthoracotomy pain relief, whereas, respiratory depression is more common with thoracic than lumbar epidural morphine.