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ANALGESIA

Lung Function After Lobectomy: A Randomized, Double-Blinded Trial Comparing Thoracic Epidural Ropivacaine/Sufentanil and Intravenous Morphine for Patient-Controlled Analgesia

Christian Bauer, MD^*, Jean-Gustave Hentz, MD, Xavier Ducrocq, MD, Meyer Nicolas, MD, Monique Oswald-Mammosser, MD^||, Annick Steib, MD, PhD, and Jean-Pierre Dupeyron, MD, PhD

From the *Department of Anesthesia and Intensive Care, Hopital Cardio-Vasculaire et Pneumologique Louis Pradel, Hospices Civils de Lyon, Lyon-Bron, France; Anesthesiology Department, Thoracic Surgery Unit, Department of Public Health, Biostatistic and Methodology Unit, and ||Department of Respiratory, Cardiocirculatory, and Exercise Physiology, University Hospital Strasbourg, Strasbourg, France.

Address correspondence and reprint requests to Christian Bauer, MD, Hospices Civils de Lyon, Hopital Cardio-Vasculaire et Pneumologique Louis Pradel, 28 Ave. du Doyen Lepine, 69677 Bron Cedex, France. Address e-mail to christian.bauer{at}chu-lyon.fr.

Abstract

BACKGROUND: Although thoracic epidural analgesia (TEA) is considered superior to IV opioids for postoperative analgesia after thoracic surgery, a few studies clearly demonstrate an improvement in pulmonary function attributable to TEA using a local anesthetic in combination with an opioid.

METHODS: In this prospective, randomized, double-blind study, we compared the effects of TEA with ropivacaine and sufentanil (TEA group) to IV morphine (IV group), as they affected pain and pulmonary function after lobectomy in 68 patients. Pain intensity, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, forced expiratory flows, and sniff nasal inspiratory pressure as a marker of inspiratory muscle strength were measured from the first to the fourth postoperative day.

RESULTS: Pain relief was better in the TEA group at rest and on coughing (P < 0.001). The impairment of FVC and FEV1 was less in the TEA group when compared with that in the IV group (P < 0.001 and P = 0.003, respectively). Sniff nasal inspiratory pressure, FEV1/FVC ratio, and expiratory flow values decreased similarly in both groups. In-hospital mortality, as well as postoperative pulmonary complications, was not different between groups.

CONCLUSION: After lobectomy, TEA enables a significant increase in pulmonary function concomitant with better pain relief than systemic morphine, although a modest intercostal motor block may occur.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999