HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ayman Abd Al-Maksoud Yousef Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Amr, Y. M. Articles by Saber, A. M. Search for Related Content PubMed PubMed Citation Articles by Amr, Y. M. Articles by Saber, A. M. Related Collections Anesthesia Related Article

---

Original Articles: General Thoracic

Effect of Preincisional Epidural Fentanyl and Bupivacaine on Postthoracotomy Pain and Pulmonary Function

Department of Anesthesiology, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt

Accepted for publication October 27, 2009.

^_* Address correspondence to Dr Amr, Department of Anesthesiology, Tanta University Hospital, Tanta, 31527, Egypt (Email: yasser.amr{at}gmail.com).

Background: This study attempts to determine whether preemptive thoracic epidural analgesia (TEA) initiated before surgical incision would reduce the severity of acute post-thoracotomy pain, its effects on pulmonary function and stress response.

Methods: Forty patients undergoing posterolateral thoracotomy received TEA either before (preoperative-TEA group) or after (postoperative-TEA group) surgery. Postoperative analgesia was maintained with epidural infusion of bupivacaine and fentanyl. Pain scores, pulmonary functions, arterial blood gases, plasma glucose, cortisol levels and epidural fentanyl consumption were compared for 48 hours after surgery.

Results: The preoperative-TEA group demonstrated significantly reduced pain scores at 2, 4, 8, 12, 24, and 48 hours at rest (p = 0.001, p = 0.002, p = 0.004, p = < 0.001, p = 0.006, and p = 0.001, respectively) and at 4, 8, 12, 24, 48 hours on coughing (p = 0.001, p = 0.001, p = 0.001, p = 0.001, p = 0.004, respectively), and a significant reduction in epidural fentanyl consumption (208.6 ± 49.3 mL, versus 260 ± 28.8 mL, p = 0.001). The preoperative-TEA group showed significant improvement in pulmonary functions as compared with the postoperative-TEA group (p < 0.05), except forced expiratory volume in one second at 24 hours (p = 0.061) and peak expiratory flow rate at 48 hours (p = 0.188). The postoperative-TEA treated patients were more likely to have a higher arterial carbon dioxide pressure at 4, 8, 12, and 24 hours (p = 0.017, p = 0.001, p = 0.003, p = 0.001), respectively. However, we could not demonstrate a statistical difference in oxygenation, cortisol, or glucose level.

Conclusions: Though preemptive TEA appeared to reduce the severity of acute pain, preserve pulmonary function, and reduce analgesic requirements, these statistically significant differences were not enough to conclude a clinical significant difference between groups.

Related Article

Invited Commentary

Frederic W. Grannis, Jr
Ann. Thorac. Surg. 2010 89: 386. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				F. W. Grannis Jr Invited Commentary Ann. Thorac. Surg., February 1, 2010; 89(2): 386 - 386. [Full Text] [PDF]