A Randomized, Double-Blind Trial Comparing Continuous Thoracic Epidural Bupivacaine With and Without Opioid in Contrast to a Continuous Paravertebral Infusion of Bupivacaine for Post-thoracotomy Pain
Journal of Cardiothoracic and Vascular Anesthesia,  Clinical Article

Grider JS et al. – The current study provided data that fill gaps in the current literature in 3 important areas. First, this study found that thoracic epidural analgesia (TEA) with bupivacaine and a hydrophilic opioid, hydromorphone, may provide enhanced analgesia over TEA or continuous paravertebral infusion (CPI) with bupivacaine alone. Second, in the bupivacaine–alone group, the increased basal rates required to achieve analgesia resulted in hypotension more frequently than in the bupivacaine/hydromorphone combination group, underscoring the benefit of the synergistic activity. Finally, in agreement with previous retrospective studies, the current data suggest that CPI of local anesthetic appears to provide acceptable analgesia for post–thoracotomy pain.

Methods
  • Patients at a tertiary care teaching hospital undergoing throracotomy for lung cancer.
  • Subjects were assigned randomly to receive a continuous thoracic epidural or paravertebral infusion.
  • Patients in the epidural group were randomized to receive either bupivacaine alone or in combination with hydromorphone.
  • Visual analog scores as well as incentive spirometery results were obtained before and after thoracotomy.
  • Seventy–five consecutive patients presenting for thoracotomy were enrolled in this institutional review board–approved study.
  • On the morning of surgery, subjects were randomized to either an epidural group receiving bupvicaine with and without hydromorphone or a paravertebral catheter–infused bupvicaine.
  • Postoperative visual analog scores and incentive spirometry data were measured in the postanesthesia care unit, the evening of the first operative day, and daily thereafter until postoperative day 4.

Results
  • Analgesia on all postoperative days was superior in the thoracic epidural group receiving bupivacaine plus hydromorphone.
  • Analgesia was similar in the epidural and continuous paravertebral groups receiving bupivacaine alone.
  • No significant improvement was noted by combining the continuous infusion of bupivacaine via the paravertebral and epidural routes.
  • Incentive spirometry goals were best achieved in the epidural bupivacaine and hydromorphone group and equal in the group receiving bupivacaine alone either via epidural or continuous paravertebral infusion.

Please login or register to follow this author.
► Click here to access PubMed, Publisher and related articles...
<< Previous Article | Next Article >>

Your Unread Messages in Anesthesiology

See All >> Messages include industry-sponsored communications and special communications from MDLinx

Most Popular Anesthesiology Articles

1 Forearm bier block: a new regional anesthetic technique for upper extremity surgery Annals of Plastic Surgery, August 8, 2014    Review Article

2 Early versus delayed administration of norepinephrine in patients with septic shock Critical Care, October 7, 2014    Clinical Article

3 Comparison of subarachnoid block with bupivacaine and bupivacaine with fentanyl on entropy and sedation: A prospective randomized double-blind study Full Text Journal of Anaesthesiology Clinical Pharmacology, October 16, 2014    Free full text    Clinical Article

4 Serious adverse events associated with vasopressin and norepinephrine infusion in septic shock Critical Care Medicine, July 23, 2014    Clinical Article

5 The comparison of the effects of dexmedetomidine, fentanyl and esmolol on prevention of hemodynamic response to intubation Full Text Revista Brasileira de Anestesiologia, October 10, 2014    Free full text    Clinical Article

6 Effect of reversal of neuromuscular blockade with sugammadex versus usual care on bleeding risk in a randomized study of surgical patients Anesthesiology, October 23, 2014    Clinical Article

7 A cricoid cartilage compression device for the accurate and reproducible application of cricoid pressure Anaesthesia, October 2, 2014    Clinical Article

8 The effect of epidural lidocaine administration on sedation of propofol general anesthesia: A randomized trial Journal of Clinical Anesthesia, October 28, 2014    Clinical Article

9 Neurodevelopmental outcomes after initial childhood anesthetic exposure between ages 3 and 10 years Journal of Neurosurgical Anesthesiology , September 12, 2014    Clinical Article

10 Neostigmine vs. sugammadex: Observational cohort study comparing the quality of recovery using the Postoperative Quality Recovery Scale Acta Anaesthesiologica Scandinavica, September 10, 2014    Clinical Article

11 Fiberoptic assessment of the Laryngeal Mask Airway (Laryseal) position after one hour of positive pressure ventilation: An observational study Journal of Clinical Anesthesia, October 30, 2014    Clinical Article

12 A comparative study of magnesium sulfate vs dexmedetomidine as an adjunct to epidural bupivacaine Full Text Journal of Anaesthesiology Clinical Pharmacology, October 22, 2014    Free full text    Clinical Article

13 Pleth variability index predicts fluid responsiveness in mechanically ventilated adults during general anesthesia for noncardiac surgery Journal of Cardiothoracic and Vascular Anesthesia, October 17, 2014    Clinical Article

14 Postoperative cognitive function following general versus regional anesthesia: A systematic review Journal of Neurosurgical Anesthesiology , September 19, 2014    Evidence Based Medicine

15 Randomized comparison of recovery time after use of remifentanil alone versus midazolam and meperidine for colonoscopy anesthesia Digestive Endoscopy, October 6, 2014    Clinical Article

16 Continuous femoral nerve block versus intravenous patient controlled analgesia for knee mobility and long-term pain in patients receiving total knee replacement: A randomized controlled trial Full Text Evidence-based Complementary and Alternative Medicine , September 3, 2014    Free full text    Clinical Article

17 Comparison of postoperative sore throat and hoarseness between two types of double-lumen endobronchial tubes: A randomized controlled trial Journal of Cardiothoracic and Vascular Anesthesia, October 13, 2014    Clinical Article

18 Intravenous angiotensin II for the treatment of high-output shock (ATHOS trial): A pilot study Critical Care, October 9, 2014    Clinical Article

19 Gastric tube insertion under direct vision using the King Vision video laryngoscope: A randomized, prospective, clinical trial Full Text BMC Anesthesiology, October 3, 2014    Free full text    Clinical Article

20 Does the type of anesthetic agent affect remifentanil effect-site concentration for preventing endotracheal tube-induced cough during anesthetic emergence?: Comparison of propofol, sevoflurane, and desflurane Journal of Clinical Anesthesia, October 29, 2014    Clinical Article

Indexed Journals in Anesthesiology: Anaesthesia, Anesthesia & Analgesia, Current Anaesthesia and Critical Caremore