DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20194196

Effectiveness of pre-emptive thoracic epidural analgesia for acute post thoracotomy pain relief: a randomised blinded study

Anupananda Chowdhury, Dipika Choudhury, Upasana Majumdar, Trina Sen

Abstract


Background: Thoracotomy is one of the most damaging surgical insults on respiratory mechanics and management of post-thoracotomy pain is a challenge. This study was conducted to compare intensity of postoperative pain, measured by VAS, in patients receiving Pre-emptive TEA compared to patients receiving epidural analgesia during surgical closure.

Method: Group A comprised of patients receiving Pre-emptive TEA with 0.1%Ropivacaine and 2 μg/ml fentanyl, 20 minutes before incision. Group B comprised of patients receiving the same drug, during surgical closure.

Results: Demographic profile was comparable between both groups. Both groups offered good analgesia, but pre-emptive group took an upper hand upto4th postoperative hour (p<0.05), both at rest and coughing. Beyond 4thhour, analgesic efficacy of both groups was comparable.

Conclusion: Pre-emptive technique offered better analgesia over the postoperative technique up to 4th postoperative hour, both at rest and coughing.


Keywords


Pre-emptive, Ropivacaine, Thoracic epidural analgesia, Visual analogue scale

Full Text:

PDF

References


Hughes R, Gao F. Pain control for thoracotomy. ContinEduc Anaesthesia, Crit Care Pain. 2005;5(2):56-60.

Bong CL, Samuel M, Ng JM, Ip-Yam C. Effects of Preemptive Epidural Analgesia on Post-thoracotomy Pain. J Cardiothorac Vasc Anesth. 2005;19(6):786-93.

Ng A, Swanevelder J. Pain relief after thoracotomy: is epidural analgesia the optimal technique? Br J Anaesth. 2007;98(2):159-62.

Ochroch EA, Gottschalk A. Impact of acute pain and its management for thoracic surgical patients. Thorac Surg Clin. 2005;15(1):105-21.

Kolettas A, Lazaridis G, Baka S, Mpoukovinas I, Karavasilis V, Kioumis I, et al. Postoperative pain management. Journal of thoracic disease. 2015 Feb;71):S62.

Wilder-Smith OHG. Pre-emptive analgesia and surgical pain. In: 2000:129:505-24.

Pöpping DM, Zahn PK, Van Aken HK, Dasch B, Boche R, Pogatzki-Zahn EM. Effectiveness and safety of postoperative pain management: a survey of 18 925 consecutive patients between 1998 and 2006 (2nd revision): a database analysis of prospectively raised data†. BJA Br J Anaesth. 2008;101(6):832-40.

Benedetti F, Amanzio M, Casadio C, Filosso PL, Molinatti M, Oliaro A, et al. Postoperative pain and superficial abdominal reflexes after posterolateral thoracotomy. The Annals of thoracic surgery. 1997 Jul 1;64(1):207-10.

Erturk E, Aydogdu Kaya F, Kutanis D, Besir A, Akdogan A, Geze S, et al. The effectiveness of preemptive thoracic epidural analgesia in thoracic surgery. BioMed research international. 2014;2014.

D’Angelo R, Gerancher JC, Eisenach JC RB. Epidural fentanyl produces labor analgesia by a spinal mechanism. Anesthesiol. 88:1519-23.

Liu S, Angel JM, Owens BD, Carpenter RL, Isabel L. Effects of epidural bupivacaine after thoracotomy. Reg Anesth Pain Med. 1995 Jul 1;20(4):303-10.

Neustein SM, Kreitzer JM, Krellenstein D, Reich DL, Rapaport E, Cohen E. Pre-emptive epidural analgesia for thoracic surgery. Mt Sinai J Med. 2002 Jan-Mar;69(1-2):101-4.

Anand LK, Sarna R, Mitra S. A comparison of 0.1% ropivacaine and 0.1% bupivacaine plus fentanyl with patient-controlled epidural analgesia for labor: a double blind study. Anaesth Pain Intensive Care. 20(3):278-84.

Dony P, Dewinde V, Vanderick B, Cuignet O, Gautier P, Legrand E, et al. The comparative toxicity of ropivacaine and bupivacaine at equipotent doses in rats. Anesth Analg. 2000;91(6):1489-92.

Yegin A, Erdogan A, Kayacan N, Karsli B. Early postoperative pain management after thoracic surgery; pre- and postoperative versus postoperative epidural analgesia: a randomised study. Eur J Cardio-Thoracic Surg. 2003;24(3):420-4.

Amr YM, Yousef AAA-M, Alzeftawy AE, Messbah WI, Saber AM. Effect of Preincisional Epidural Fentanyl and Bupivacaine on Postthoracotomy Pain and Pulmonary Function. Ann Thorac Surg. 2010;89(2):381-5.

Aguilar JL, Rincón R, Domingo V, Espachs P, Preciado MJ, Vidal F. Absence of an early pre-emptive effect after thoracic extradural bupivacaine in thoracic surgery. Br J Anaesth. 1996;76(1):72-6.

Atashkhoyi S, Jafari Shobeiri M, Azari Kalejahi A, Hatami Marandi P. A comparison of pre-emptive with preventive epidural analgesia in the patients undergoing major gynecologic surgery. African J Pharm Pharmacol. 2013;7(6):245-9.

Roberts GW, Bekker TB, Carlsen HH, Moffatt CH, Slattery PJ, McClure AF. Postoperative nausea and vomiting are strongly influenced by postoperative opioid use in a dose-related manner. Anesthesia and analgesia. 2005; 101(5):1343-8.

Curatolo M, Scaramozzino P, Venuti FS, Orlando A, Zbinden AM. Factors associated with hypotension and bradycardia after epidural blockade. Anesth Analg. 1996 Nov;83(5):1033-40.