Anesth Pain Med.  2015 Apr;10(2):82-88. 10.17085/apm.2015.10.2.82.

Clinical benefits of preemptive thoracic epidural analgesia with hydromorphone and bupivacaine in open thoracotomy lung surgery

• Lee SH
• Sim WS
• Yang M
• Kim JA
• Ahn HJ
• Shin BS
• Lim HY
• Kim DY
• Yoon JS

• KMID: 2148039
• DOI: http://doi.org/10.17085/apm.2015.10.2.82

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.

Keyword

Analgesia; Bupivacaine; Epidural; Hydromorphone; Pulmonary function test; Thoracotomy

MeSH Terms

Analgesia
Analgesia, Epidural*
Bupivacaine*
Central Nervous System
Chronic Pain
Follow-Up Studies
Humans
Hydromorphone*
Hypotension
Incidence
Lung*
Morphine
Nausea
Pruritus
Respiratory Function Tests
Respiratory Insufficiency
Tea
Thoracotomy*
Weights and Measures
Wounds and Injuries
Bupivacaine
Hydromorphone
Morphine
Tea