Post-thoracotomy analgesia: epidural vs intravenous morphine continuous infusion.

Back­ground. We com­pared tho­rac­ic mor­phine epi­du­ral anal­ge­sia (TEA) and I.V. anal­ge­sia (IVA) ­with mor­phine, in ­respect to the ­time to extu­ba­tion, the qual­ity of post­op­er­a­tive anal­ge­sia, ­side ­effects, com­pli­ca­tions, post­op­er­a­tive hos­pi­tal ­length of ­stay in ­patients hav­ing thor­a­cot­o­my ­lung resec­tion. Meth­ods. We pros­pec­tive­ly stud­ied 563 con­sec­u­tive ­patients, under­go­ing thor­a­cot­o­my (lobec­to­my, bilo­bec­to­my or pneu­mo­nec­to­my), ran­dom­ized in two ­groups: TEA 286 ­patients and IVA 277 ­patients. In the epi­du­ral ­group, ­before the induc­tion of anes­the­sia, con­tin­u­ous infu­sion of 15 mg of mor­phine in 250 mL of nor­mal ­saline at 5 mL/h was start­ed. In the IVA ­group a con­tin­u­ous infu­sion of 30 mg of mor­phine asso­ciat­ed ­with 180 mg ketor­o­lac in 250 mL of nor­mal ­saline at 5 mL/h was start­ed ­before the induc­tion of anes­the­sia. The ­pain ­degree was eval­u­at­ed on an ana­log­ic ­scale by ­Keele mod­i­fied at 1 (end of anes­the­sia) 6, 12, 24, and 48 post­op­er­a­tive ­hours, at ­rest and after move­ments. ­Data ­obtained ­were ana­lysed by ­means of the anal­y­sis of var­i­ance for repeat­ed meas­ures. Results. The ­time ­from the end of sur­gery to tra­cheal extu­ba­tion was sim­i­lar in ­both ­groups. Sig­nif­i­cant­ly low­er numer­ic ver­bal ­pain ­scores at ­rest and after move­ments ­were ­found in the epi­du­ral ­group (p<0.001). Post­op com­pli­ca­tions, nau­sea and vom­it­ing ­were high­er in the IVA ­group (p<0.05). Post­op­er­a­tive ­mean hos­pi­tal ­length of ­stay was 9±4 ­days in TEA and 11±4 in the IVA ­group (p<0.05). Con­clu­sions. In our ­study the epi­du­ral ­root was super­i­or in ­terms of anal­ge­sia, ­side ­effects, ­length of ­stay and post­op­er­a­tive com­pli­ca­tions ­after thor­a­cot­o­my.