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

Abstract

PURPOSE:

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.

• Authors: Masakazu Yoshioka, Takeshi Mori, Hironori Kobayashi, Kazunori Iwatani, Kentaro Yoshimoto, Hidenori Terasaki, Hiroaki Nomori
• Journal: Annals 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
• PMID: 17095972 (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