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CARDIOVASCULAR ANESTHESIA

The Effects of Three Different Analgesia Techniques on Long-Term Postthoracotomy Pain

Mert entürk, MD^*, Perihan Ergin Özcan, MD^*, Gül Köknel Talu, MD^*, Esen Kiyan, MD, Emre Çamci, MD^*, Süleyman Özyalçin, MD^*, ükrü Dilege, MD, and Kamil Pembeci, MD^*

Departments of *Anesthesiology, Respiratory Diseases, and Surgery, Medical Faculty of stanbul, University of stanbul, Turkey

Address correspondence and reprint requests to Mert entürk, st. Üni. stanbul Tip Fakültesi, Anesteziyoloji Anabilim Dali, Çapa 34390, stanbul, Turkey. Address e-mail to senturkem{at}superonline.com

In this clinical, randomized, prospective study, we compared the effects of three different analgesia techniques (thoracic epidural analgesia [TEA] with and without preoperative initiation and IV patient-controlled analgesia [IV-PCA]) on postthoracotomy pain in 69 patients. In two groups, a thoracic epidural catheter was inserted preoperatively. Group Pre-TEA had bupivacaine and morphine solution preoperatively and intraoperatively. Postoperative analgesia was maintained with epidural PCA with a similar solution. Group Post-TEA, with no intraoperative medication, had the same postoperative analgesia as Group Pre-TEA plus the bolus dose. Group IV-PCA received only IV-PCA with morphine for postoperative analgesia. Pain was evaluated every 4 h during the first 48 h at rest, cough, and movement. Pre-TEA was associated with decreased pain compared with the other groups. Six months later, the patients were asked about their pain. The incidence and the intensity of pain were most frequent in Group IV-PCA (78%) and were the least in Group Pre-TEA (45%) (Group Pre-TEA versus Group IV-PCA, P = 0.0233; Group Pre-TEA versus Group IV-PCA, P = 0.014). Patients having pain on the second postoperative day had 83% chronic pain. TEA with preoperative initiation is a preferable method in preventing acute and long-term thoracotomy pain.

IMPLICATIONS: Preoperatively initiated thoracic epidural analgesia has the most satisfying results in controlling postthoracotomy pain in the acute and long-term period, and it is associated with a decreased incidence (and intensity) of chronic pain compared with postoperative (epidural or IV) analgesia. Chronic pain has an incidence of 62%.

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