Abstract
This study aims to investigate the effects of thoracic epidural analgesia, before and after surgical incision and in the postoperative period, on thoracotomy pain and stress response. A total of 45 patients who were scheduled for posterolateral thoracotomy were included in this study. A combination of epidural levobupivacaine and morphine was administered as a bolus before incision (Group 1; n=15), after incision (Group 2; n=15), or at the end of surgery (Group 3; n=15). Additionally, infusion was used in Group 1 and Group 2 during operation. Postoperative patient-controlled epidural analgesia infusion pumps were connected to all patients. Visual analog scale (VAS) scores and morphine consumption were recorded during the postoperative 48 h. Glucose, insulin, cortisol, and C-reactive protein (CRP) levels were compared before surgery and at 4, 24, and 48 h after the operation. There were no differences in the morphine consumption and VAS scores for all measurements among the groups (P > 0.05). Both blood glucose levels at 4 h and CRP values at 48 h were higher in Group 2 than Group 1 (P < 0.05). Cortisol levels at 4, 24, and 48 h after the operation were similar to baseline values in all groups (P > 0.05). The application of thoracic epidural analgesia before and after surgical incision and in the postoperative period did not result in a significant difference in the severity of the postthoracotomy pain and stress response in all groups. Based on our results, we suggest that epidural levobupivacaine combined with morphine provides an effective and safe analgesia and can partially suppress surgical stress response.
Highlights
Postthoracotomy pain is one of the most painful postoperative pain types
The application of thoracic epidural analgesia before and after surgical incision and in the postoperative period did not result in a significant difference in the severity of the postthoracotomy pain and stress response in all groups
We suggest that epidural levobupivacaine combined with morphine provides an effective and safe analgesia and can partially suppress surgical stress response
Summary
Postthoracotomy pain is one of the most painful postoperative pain types. And effective postthoracotomy pain management provides improved pulmonary functions and reduces the complication rates [1,2]. Inadequate postthoracotomy analgesia results in decreased normal and deep breathing, ineffective coughing, retention of bronchial secretions, atelectasis, and acute restrictive pulmonary disease [2]. Thoracic epidural analgesia is accepted as the gold standard in postthoracotomy pain treatment [1]. Postoperative pain, originating from tissue damage due to surgical trauma, is a type of nociceptive pain accompanied by central and peripheral sensitization. Preemptive analgesia means avoiding pain by initiating the treatment before trauma or surgery [3,4,5]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call