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Anesth Pain Med > Volume 10(2); 2015 > Article
Spinal Pain
Anesthesia and Pain Medicine 2015;10(2):82-88.
DOI: https://doi.org/10.17085/apm.2015.10.2.82    Published online April 30, 2015.
Clinical benefits of preemptive thoracic epidural analgesia with hydromorphone and bupivacaine in open thoracotomy lung surgery
Sang Hyun Lee, Woo Seok Sim, Mikyung Yang, Jie Ae Kim, Hyun Joo Ahn, Byung Seop Shin, Hyun Young Lim, Do Yeon Kim, Jin Sun Yoon
1Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. anesthe@skku.edu
2Department of Anesthesiology and Pain Medicine, Veteran Health Service Medical Center, Seoul, Korea.
Received: 5 December 2014   • Revised: 23 December 2014   • Accepted: 14 January 2015
Abstract
BACKGROUND
Preemptive analgesia is known to decrease the sensitization of the central nervous system and reduce subsequent amplification of nociceptive stimuli. We investigated whether preemptive thoracic epidural analgesia (TEA) demonstrated intraoperative and postoperative short and long term clinical advantages.
METHODS
Thirty patients scheduled for open thoracotomy were randomly allocated to one of two groups to receive continuous TEA (0.15% bupivacaine and 8 microg/ml hydromorphone) either before surgical incision (preemptive group) or at the end of the operation (nonpreemptive group). Incidence of hypotension during surgery was recorded. Numerical rating scales (NRS) and the incidence of side effects such as nausea, pruritus, sedation, hypotension, and respiratory depression were recorded at 2, 6, 24, and 48 hours postoperatively. Pulmonary function test (PFT) was performed before, 24 and 48 hours after the operation. Persistence of pain control was investigated at 6 months postoperatively.
RESULTS
The NRS score, side effects, and PFT changes were comparable between the two groups. TEA and intravenous rescue morphine consumed at 2, 6, 24, and 48 hours postoperatively were not different between the two groups. During surgery, the incidence of hypotension was significantly higher in the preemptive group (P = 0.027). At 6-month follow up, two patients in the nonpreemptive group complained of persistent pain at wound and none in the preemptive group.
CONCLUSIONS
Preemptive TEA with hydromorphone and bupivacaine during surgery may cause unnecessary intraoperative hypotension without a prominent advantage in reducing acute or chronic pain or enhancing pulmonary function after thoracotomy. The advantageous concept of preemptive TEA may be dubious and may not provide perioperative clinical benefits.
Key Words: Analgesia, Bupivacaine, Epidural, Hydromorphone, Pulmonary function test, Thoracotomy
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