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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2002 September;68(9):681-93

language: English, Italian

Post-thoracotomy analgesia: epidural vs intravenous morphine continuous infusion

Della Rocca G., Coccia C., Pompei L., Costa M. G., Pierconti F., Di Marco P., Tommaselli E., Pietropaoli P.

Department of Anesthesiology and Resuscitation, Umberto I Polyclinic Hospital, University of Rome “La Sapienza”, Rome, Italy


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.

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