Post-thoracotomy analgesia comparison epidural fentanyl to intravenous pethidine

ABSTRACT

To evaluate the efficacy of post-thoracotomy analgesia with intermittent epidural fentanyl. 50 patients were allocated randomly into 2 groups. The first group received intermittent epidural fentanyl and the second group received intermittent intravenous analgesia using pethidine. The variables studied were pain score; total amount of additional intravenous opioid analgesia, and ventilatory function parameters [forced vital capacity [FVC], forced expiratory volume in the first second [FEV[1]] and FEV[1]/FVC ratio]. In the first postoperative day, pain scores were higher in the epidural group [P = 0.034], but there was no significant difference between mean pain scores in the second and third days [P = 0.61, P = 0.15, respectively]. On all three days, significantly more additional analgesics were required in the epidural group. A difference was found between both groups in the post- to pre-operative FEV[1], FVC and FEV[1]/FVC ratios, with the better preservation of the ventilatory function in the epidural group [P= 0.001, 0.013, O.0001, respectively]. The analgesic effect of intermittent epidural fentanyl is not adequate, and postoperative pain relief has not any significant advantage over the more easily-applied intravenous analgesia. However, better preservation of ventilatory function makes epidural fentanyl a useful adjunct analgesia in reduction of post-thoracotomy pulmonary complications