A Comparison of the Effectiveness of a Continuous Lumbar Epidural Infusion of Preservative Free Morphine with a Continuous Thoracic Epidural Infusion of 0.0625% Bupivacaine Plus Fentanyl in Providing Post-Thoracotomy Analgesia
Master's thesis, Jan-Dec 1998
TEXAS UNIV HEALTH SCIENCE CENTER AT HOUSTON
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Controversy exists as to which epidural approach, thoracic or lumbar, provides more effective post-thoracotomy analgesia The quasi-experimental study compared the analgesic efficacy of these two approaches using site appropriate analgesics based on their pharmacokinetic profiles. The investigators hypothesized that there would be no difference in the post-thoracotomy analgesia provided by the lumbar epidural approach using preservative-free Morphine as compared to the thoracic epidural approach using Bupivacaine 0.0625 with Fentanyl. Data were collected on 20 subjects who presented for a thoracotomy and had consented to an epidural for their post-thoracotomy analgesia. Subjects were randomized into either the thoracic or the lumbar group. An epidural analgesia protocol was used for both groups. Postoperative pain was assessed by evaluating Visual Analog Scale scores. Additionally, the investigators evaluated the need for supplemental analgesic requirements, side effects and the time to first analgesic after epidural analgesics were discontinued. The results of this study showed no statistically significant differences between the thoracic and lumbar epidural groups. Furthermore, data indicated that both the thoracic and lumbar epidural approaches provided subjects with adequate post-thoracotomy analgesia. The investigators concluded that it is possible to control post-thoracotomy pain with the lumbar epidural approach and that both approaches should be considered when managing post-thoracotomy analgesia. It is recommended that anesthesia care providers who are not proficient in the thoracic approach should consider using the lumbar approach for post-thoracotomy analgesia.
- Medicine and Medical Research