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Ann Thorac Surg 1995;59:1039-1040
© 1995 The Society of Thoracic Surgeons

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Correspondence

Epidural Butorphanol Betters Fentanyl, Morphine Options

Department of Anesthesiology, St. Louis Regional Medical Center, St. Louis, MO 63112

To the Editor:

The general efficacy of postthoracotomy pain management using continuous epidural analgesia (narcotic plus bupivacaine) has been supported enthusiastically by review of 1,324 patient examples recently published in The Annals [1].

Would it be more than a quibble to discuss some aspects of these methods of Lubenow and associates [1]? A thoracic epidural catheter was placed in all their patients. But in a randomized, double-blind comparison of (simpler, safer) lumbar versus thoracic epidural infusion of fentanyl (without bupivacaine), excellent and equal analgesia was found, after thoracotomy, by either approach [2].

An incidence of urinary retention sufficient ``to warrant the routine use of urinary catheters'' [1] is attributable directly to the mu opioids (morphine, fentanyl) chosen for epidural injection [3]. The 14% incidence of pruritis [1] also reflects mu opioid action.

For postthoracotomy epidural analgesia I prefer to administer the kappa opioid butorphanol. Although a cesarean section is not a thoracotomy, ``the adequacy of [epidural] analgesia was indistinguishable between morphine and butorphanol'' [4]. Butorphanol causes neither pruritis nor urinary retention; alone it provides excellent (lumbar) epidural postthoracotomy analgesia.

References

1. Lubenow TR, Faber LP, McCarthy RJ, Hopkins EM, Warren WH, Ivankovich AD. Postthoracotomy pain management using continuous epidural analgesia in 1,324 patients. Ann Thorac Surg 1994;58:924–30.[Abstract]
2. Coe A, Sarginson R, Smith MW, Donnelly RJ, Russell GN. Pain following thoracotomy: a randomized, double-blind comparison of lumbar versus thoracic epidural fentanyl. Anaesthesia 1991;46:918–21.[Medline]
3. Dray A. Epidural opiates and urinary retention: new models provide new insights. Anesthesiology 1988;68:323–4.[Medline]
4. Palacios QT, Jones MM, Hawkins JL, et al. Post-cesarean section analgesia: a comparison of epidural butorphanol and morphine. Can J Anaesth 1991;38:24–30.[Medline]

This Article Alert me when this article is cited Alert me if a correction is posted 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 Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Gould, D. B. Search for Related Content PubMed PubMed Citation Articles by Gould, D. B.