PATIENT CONTROLLED EPIDURAL ANALGESIA : INTEREST IN THORACIC SURGERY

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Vol. 86 No. 2 (2008): Issue Feb 2008

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Walid Kammoun
Service d'Anesthésie-Réanimation à CHU Mongi Slim - La Marsa - Tunisie
Tahar Mestiri
Service de Chirurgie Thoracique Hôpital Abderrahmen Mami - L'Ariana Tunisie.
Walid Miraoui
Service d'Anesthésie-Réanimation à CHU Mongi Slim - La Marsa - Tunisie
Nabil Frikha
Service d'Anesthésie-Réanimation à CHU Mongi Slim - La Marsa - Tunisie
Mhamed Sami Mebazaa
Service d'Anesthésie-Réanimation à CHU Mongi Slim - La Marsa - Tunisie
Tarak Kilani
Service de Chirurgie Thoracique Hôpital Abderrahmen Mami - L'Ariana Tunisie.
Mohamed Salah Ben Ammar
Service d'Anesthésie-Réanimation à CHU Mongi Slim - La Marsa - Tunisie

Abstract

Aim : To compare efficacy of pain control, the consumption of local anaesthetics and opioids as well as the side effects between continuous epidural analgesia, patient controlled analgesia and patient controlled epidural analgesia in thoracic surgery.
Methods : Prospective randomised study included 66 patients who had thoracotomy. Patients were divided into 3 groups, to receive different pain control methods.
Group 1 (n=22) received patient control analgesia
Group 2 (n=22) received continuous epidural analgesia (Bupivacaine 0,125% + 5 μg/ml of Fentanyl) between 6 and 10 ml/h in order to obtain a T2 level
Group 3 (n=22) received patient controlled epidural analgesia (Bupivacaine 0, 08% + 3μg/ml of Fentanyl) 6ml/h and bolus of 5ml.
Results : There was no difference between the three groups in age, delay of surgical operation and per operative morphine consumption. VAS was less at rest and after cough in patient group with patient controlled epidural analgesia. The difference was less significant in local anaesthetics and opioids consumption in patient with controlled epidural analgesia.
Conclusion : The benefit of patient controlled epidural analgesia in thoracic surgery is proven by the following analgesic efficiency which allows good respiratory rehabilitation, decreasing the risk of drug toxicity by decreases consumption, weak hemodynamic effects and absence of motor block.

Keywords:

Thoracotomy, post operative pain, epidural analgesia

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References

  1. Hughes R, Gao F. Pain Control For Thoracotomy. Contin Educ Anaesth Crit Care Pain 2005 ; 5 : 56-60.
  2. Kavangh Bp, Katz J, Sandler As. Pain Control After Thoracic Surgery. A Review Of Current Techniques. Anesthesiology 1994 ; 81 : 737-759.
  3. Joris J, Sferlazza A, Vanerk J, Lamy M. Patient-Controlled Analgesia With Opiate Is Not Significantly Influenced By Programmation, Choice Of Narcotics And Combination With A Minor Analgesic. Regional Anesth 1992; 17 (3s) : 153.
  4. Roy Gs, Eugene Sf. Acute Pain Management For Patients Undergoing Thoracotomy. Ann Thorac Surg 2003 ; 75 : 1349-57.
  5. Scott Da, Beilby Ds, Mcclymont C. Postoperative Analgesia Using Epidural Infusion Of Fentanyl With Bupivacaine : A Prospective Analysis Of 1014 Patients. Anesthesiology 1995; 83 : 727-737.
  6. Hansdottir V, Bake B, Nordberg G. The Analgesic Efficacy And Adverse Effects Of Continuous Epidural Sufentanil And Bupivacaine Infusion After Thoracotomy. Anesth-Analg, 1996 ; 83 : 394-400
  7. Boylan Jf, Katz J, Kavanagh Bp Et All. Epidural Bupivacaine- Morphine Analgesia Versus Patient-Controlled Analgesia Following Abdominal Aortic Surgery : Analgesic, Respiratory And Myocardial Effects. Anesthesiology 1998 ; 89 : 585-93
  8. Scott , Beilby D, Mcclymont C, Anaes F. Postoperative Analgesia Using Epidural Infusions Of Fentanyl With Bupivacaine. Anesthesiology 1995 ; 83 : 727-737.
  9. Mourisse J, Hasenbos M, Gielen M, Moll Je Et All. Epidural Bupivacaine, Sufentanil Or The Combination For Post-Thoracotomy Pain. Acta Anaesthesiologica Scandinavica 1992 ; 36 : 70-4.
  10. Mahon Sv, Berry PD, Jackson M Et All. Thoracic Epidural Infusions For Post-Thoracotomy Pain: A Comparison Of Fentanyl-Bupivacaine Mixtures Vs. Fentanyl Alone. Anaesthesia 1999 ; 54 : 641-646
  11. Rosenfeld Ba, Beattie C., Christopherson R Et All. The Perioperative Ischemia Randomized Anesthesia Trial Study Group: The Effects Of Different Anesthetic Regimens On Fibinolysis And The Development Of Postoperative Atrial Thrombosis. Anesthesiology
  12. Ga Mcleod, C Cumming. Thoracic Epidural Anaesthesia And Analgesia. Contin Educ Anaesth Crit Care Pain 2004 ; 4 ; 16-19
  13. Richardson J, Sababathan S, Jones J, Shah R.D, Et All. A Prospective, Randomized Comparison Of Preoperative And Continuous Balanced Epidural Or Paravertebral Bupivacaine On Post-Thoracotomy Pain, Pulmonary Function Ans Stress Response. Bja 1999 ; 83
  14. Beattie W.S, Buckley D, Forrest J. Epidural Morphine Reduces The Risk Of Postoperative Myocardial Ischemia In Patients With Cardiac Risk Factors. Can J Anesth 1993 ; 40 : 532-41.
  15. Wigfull J; Welchew E. Survey Of 1057 Patients Receiving Postoperative Patient-Controlled Epidural Analgesia. Anesthesia 2001 ; 56 : 70-75.
  16. Aranda M; Kim P; Cordek Fc Et All. Demographics And Outcome Of Patient Controlled Epidural Analgesia In Patients After Thoracic Surgery. Crit Care Med 1999; 27 : A144.
  17. Curry Pd, Pacsoo C, Heap Dg. Patient-Controlled Epidural Analgesia In Obstetric Anesthetic Practice. Pain 1994 ; 57 : 125-128.
  18. Snijdelaar D And Al. High Thoracic Epidural Sufentanil With Bupivacaine: Continuous Infusion Of High Volume Versus Low Volume. Anesth Analg 1994 ; 78 : 490-4