Effectiveness of pre-emptive thoracic epidural analgesia for acute post thoracotomy pain relief: a randomised blinded study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20194196Keywords:
Pre-emptive, Ropivacaine, Thoracic epidural analgesia, Visual analogue scaleAbstract
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.
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.
