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The efficacy of epidural analgesia after video-assisted thoracoscopic surgery: a randomized control study.

AbstractPURPOSE:
Video-assisted thoracoscopic surgery (VATS) is known to reduce the severity of pain after surgery. However, it has not yet been established whether epidural anesthesia/analgesia (EA) is necessary after VATS. We therefore conducted a randomized control study to examine whether or not EA is necessary for pain control after VATS.
PATIENTS AND METHODS:
Forty-six patients undergoing VATS were randomly allocated to one of 2 groups: 24 who were given EA after the procedure (EA group) and 22 who were not (NEA group). Patients in the EA group received a continuous infusion of fentanyl and bupivacaine via an epidural catheter for 2 days after VATS. The degree of postoperative pain was assessed on the total dose of additional analgesics administered, a visual analog scale (VAS), a verbal pain score at rest (VPS-R) and on movement (VPS-M), from the day of surgery to the 2nd postoperative day (2 POD).
RESULTS:
Additional use of rectal diclofenac sodium and intramuscular pentazocine was more frequent in the NEA group than in the EA group (p<0.05). The VAS, VPS-R, and VPS-M scores were significantly lower in the EA group than in the NEA group at 0 POD, from 0 to 1 POD, and from 0 to 2 POD, respectively (p<0.0001-0.05). Stepwise regression analysis revealed that EA was a significant independent variable of VPS-R and VPS-M from 0 to 1 POD (p<0.05). However, the incidence of nausea/vomiting in the EA group was 29%, which was more frequent than in the NEA group (5%) (p<0.05).
CONCLUSION:
While EA causes nausea/vomiting in some patients, it is effective for pain control until 1 POD after VATS, especially for pain on movements.
AuthorsMasakazu Yoshioka, Takeshi Mori, Hironori Kobayashi, Kazunori Iwatani, Kentaro Yoshimoto, Hidenori Terasaki, Hiroaki Nomori
JournalAnnals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia (Ann Thorac Cardiovasc Surg) Vol. 12 Issue 5 Pg. 313-8 (Oct 2006) ISSN: 1341-1098 [Print] Japan
PMID17095972 (Publication Type: Journal Article, Randomized Controlled Trial)
Chemical References
  • Analgesics, Opioid
  • Anesthetics, Local
  • Fentanyl
  • Bupivacaine
Topics
  • Analgesia, Epidural (methods)
  • Analgesics, Opioid (administration & dosage)
  • Anesthetics, Local (administration & dosage)
  • Bupivacaine (administration & dosage)
  • Catheterization
  • Fentanyl (administration & dosage)
  • Follow-Up Studies
  • Humans
  • Injections, Epidural
  • Lung Neoplasms (surgery)
  • Middle Aged
  • Pain Measurement
  • Pain, Postoperative (therapy)
  • Pneumonectomy (methods)
  • Postoperative Care (methods)
  • Retrospective Studies
  • Thoracic Surgery, Video-Assisted
  • Treatment Outcome

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