[Postoperative analgesia with thoracic peridural morphine in pulmonary surgery. 117 cases]. / Analgésie postopératoire par la morphine péridurale thoracique en chirurgie pulmonaire. Cent dix-sept observations.

ABSTRACT

Post-operative analgesia by peridural injection of morphine in the thoracic spine was evaluated in a series of 117 successive patients with pulmonary pathology operated upon by the same surgeon. The catheters were introduced, either on the day preceding the operation or at the end of it, above or below T6-T7, after localization of the peridural space by the hanging drop technique or by loss of resistance to a liquid mandrel; 5 mg of preservative-free morphine diluted in 3 ml isotonic saline were injected. The catheter was left in situ for 3 days, then systematically removed and cultivated. Analgesia was considered excellent in 66.7% of the cases, good in 26.5% and insufficient or non-existent in 6.8%. Each dose was effective for 15 hours on average. The mean total dose administered was 18.2 mg and did not exceed 40 mg during the first three post-operative days. There was no respiratory depression requiring naloxone or mechanical ventilation. Urinary retention occurred in 62% of the patients and troublesome pruritus in 0.3%. No death attributable to the method and no neurological or infectious complication was noted. There was no problem in removing the catheter, and no redness, pain or haematoma was observed at the site of injection. In view of the potential risk of insidious and delayed respiratory depression, the patients must be closely supervised specialized by staff. This technique must not be used unless the conditions required are fulfilled.