EPIDURAL NARCOTIC ANALGESIA AFTER THORACOTOMY

The benefits of epidural narcotic analgesia (ENA) have been documented in mixed surgical populations. To assess the safety and utility of EN A after thoracic surgery and to assess potential interactions with int raoperative intravenous narcotics (IIN), we retrospectively examined t he records of 130 consecutive patients having thoracotomy. The 116 pat ients who received ENA required a mean of 0.19 mg/kg of intravenous mo rphine sulfate (MS) within the first 48 postoperative hours, as oppose d to 0.44 mg/kg for patients who did not receive ENA. The place in whi ch nonepidural patients were extubated most frequently was the operati ng room (71%): followed by the intensive care unit (21%) and the recov ery room (7%). Percentages were similar for epidural patients: 71% wer e extubated in the operating room, 20% in the intensive care unit, and 9% in the recovery room. Nonepidural patients had an immediate mean p ostoperative PCO2 of 39.2 mm Hg, epidural patients a mean of 40.1 mm H g. There were no technical complications due to epidural catheter plac ement, and no reintubation was required within the first 72 postoperat ive hours. The concomitant administration of IIN did not produce a sig nificant difference in postextubation PCO2 in either group of patients , although increasing doses resulted in a lower percentage of patients extubated in the operating room or recovery room. We conclude that EN A may be safely administered to patients having thoracotomy, and it di minishes the need for postoperative intravenous narcotics.