ORIGINAL ARTICLES  ANESTHESIA Free access

Minerva Anestesiologica 2005 April;71(4):137-46

Copyright © 2005 EDIZIONI MINERVA MEDICA

language: English, Italian

Perioperative analgesia in pulmonary surgery

Palermo S. ¹, Gastaldo P. ², Malerbi P. ², Benvegnù G. ², Nicoscia S. ¹, Launo C. ¹

¹ Pain Therapy Unit University of Genoa, Genoa 2 DiSCAT Anaesthesia Department University of Genoa, Genoa

Aim. In pulmonary surgery many studies have shown how pain associated with residual doses of anaesthetic drugs can cause a decrease in pulmonary volumes and depression of the cough reflex. Both these phenomena are responsible for a rising incidence of postoperative mortality and morbility. The most widely used postoperative analgesic techniques are continuos systemic analgesia and epidural analgesia. The aim of this study is to verify the advantages and the disadvantages of both analgesic techniques.
Methods. Fifty patients, undergoing pulmonary surgery, were recruited and divided, after randomization into 2 groups. Patients included in A group received an epidural administration of naropina 0.2%+fentanyl 4 µg/mL by elastomeric pump (rate 5 ml/h). Patients included in B group received an ev continuos infusion of tramadol 600 mg+ketorolac trometamina 120 mg+ranitidina 200 mg+ondansetron 16 mg by elastomeric pump (rate 5 ml/h for 48 hours).
Results. Both groups showed good analgesic effects. Pain rest relief was between 3 and 1.7 points in group B and between 2.5 and 0.4 points in group A. Incident pain was 4.8 at awekening time and it decreesed to 4 after 48 hours in group B while in group A it was from 3.2 to 1.8 in the same period of B group.
Conclusion. Our data show that both analgesic techniques are able to guarantee a good rest pain relief after toracotomy. Epidural analgesia showed more efficacy as for as incident pain relief but it was more difficult to realise and it showed less acceptance by patients.