Abstract
Post-thoracotomy pain is a severe and intense pain caused by trauma to ribs, muscles and peripheral nerves. The current study aimed to compare subpleural analgesia (SPA) with thoracic epidural analgesia (TEA) in patients undergoing thoracotomy. Randomized study at Ankara Numune Education and Research Hospital, in Turkey. Thirty patients presenting American Society of Anesthesiologists physical status I-III were scheduled for elective diagnostic thoracotomy. The patients were randomized to receive either patient-controlled SPA or patient-controlled TEA for post-thoracotomy pain control over a 24-hour period. The two groups received a mixture of 3 µg/ml fentanyl along with 0.05% bupivacaine solution through a patient-controlled analgesia pump. Rescue analgesia was administered intravenously, consisting of 100 mg tramadol in both groups. A visual analogue scale was used to assess pain at rest and during coughing over the course of 24 hours postoperatively. In the SPA group, all the patients required rescue analgesia, and five patients (33%) required rescue analgesia in the TEA group (P < 0.05). Patients who received subpleural analgesia exhibited higher visual analogue scores at rest and on coughing than patients who received thoracic epidural analgesia. None of the patients had any side-effects postoperatively, such as hypotension or respiratory depression. Thoracic epidural analgesia is superior to subpleural analgesia for relieving post-thoracotomy pain. We suggest that studies on effective drug dosages for providing subpleural analgesia are necessary.
Highlights
Post-thoracotomy pain is a severe and intense pain caused by trauma to ribs, muscles and peripheral nerves
The mean dose of tramadol consumed as rescue analgesia postoperatively in the subpleural analgesia (SPA) group was 380 mg, compared with 120 mg in the thoracic epidural analgesia (TEA) group (P = 0.002; Mann-Whitney U test)
The mean number of patient-controlled analgesia (PCA) boluses used was significantly lower in the TEA group: 7 in the TEA group versus 28 in the SPA group (P < 0.002; Mann-Whitney U test)
Summary
Post-thoracotomy pain is a severe and intense pain caused by trauma to ribs, muscles and peripheral nerves. Thoracic epidural analgesia is the gold standard for pain relief after thoracotomy, and because of its many beneficial effects, such as reduction of intraoperative opioid requirements, improvement of postoperative cardiopulmonary function and suppression of stress response.. Thoracic epidural block is usually performed percutaneously, with considerable failure rates. It is contraindicated in patients who are using anticoagulant or antiplatelet drugs.. Intercostal nerve block, intrathecal administration of opioids and interpleural analgesia have been developed as alternative regional techniques for post-thoracotomy pain management.. Intercostal nerve block, intrathecal administration of opioids and interpleural analgesia have been developed as alternative regional techniques for post-thoracotomy pain management.5 Many of these techniques are claimed to provide good pain control, but studies to ascertain the ideal technique are still ongoing.. It is contraindicated in patients who are using anticoagulant or antiplatelet drugs. Intercostal nerve block, intrathecal administration of opioids and interpleural analgesia have been developed as alternative regional techniques for post-thoracotomy pain management. Many of these techniques are claimed to provide good pain control, but studies to ascertain the ideal technique are still ongoing. There have not been enough studies on the subject of subpleural catheters for patient-controlled subpleural analgesia
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