Pain outcomes after thoracotomy: lumbar epidural hydromorphone versus intrapleural bupivacaine

J Cardiothorac Vasc Anesth. 1995 Oct;9(5):534-7. doi: 10.1016/s1053-0770(05)80136-3.

Abstract

Objective: To evaluate postthoractomy analgesia in patients receiving lumbar epidural hydromorphone versus intrapleural bupivacaine.

Design: A randomized, prospective, double-blind study.

Setting: A university-affiliated medical center.

Participants: Twenty patients undergoing lateral thoracotomy for either pulmonary wedge resection, lobectomy, or pneumonectomy.

Intervention: Nine patients received epidural hydromorphone, and 11 patients received intrapleural bupivacaine in the postoperative period.

Measurements and main results: Severity of pain was assessed using a visual analog pain scale (VAPS) (0 to 100 mm) at 1, 3, and 5 hours. Patients receiving epidural hydromorphone had a statistically significant improvement in VAPS scores. Patients who received intrapleural bupivacaine did not achieve a significant reduction in pain scores. Nine of 11 patients in the intrapleural bupivacaine group had "failed" postoperative analgesia as defined by a VAPS greater than 30. Only 3 of 9 patients in the continuous epidural hydromorphone group had "failed" analgesia.

Conclusion: Epidural hydromorphone is superior to intrapleural bupivacaine in achieving satisfactory pain outcomes during the first 5 hours after thoracotomy.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Analgesia, Epidural
  • Analgesics, Opioid / administration & dosage*
  • Anesthetics, Local / administration & dosage*
  • Bupivacaine / administration & dosage*
  • Double-Blind Method
  • Female
  • Humans
  • Hydromorphone / administration & dosage*
  • Infusions, Parenteral
  • Male
  • Middle Aged
  • Pain Measurement
  • Pain, Postoperative / drug therapy*
  • Pain, Postoperative / physiopathology
  • Prospective Studies
  • Thoracotomy*
  • Treatment Outcome

Substances

  • Analgesics, Opioid
  • Anesthetics, Local
  • Hydromorphone
  • Bupivacaine