Pain relief after esophagectomy: Thoracic epidural analgesia is better than parenteral opioids

Objective: To compare postoperative pain relief and pulmonary function in p atients after thoracoabdominal esophagectomy treated by continuing perioper ative thoracic epidural anesthesia or changing to parenteral opioids. Design: Prospective, randomized study, Setting: University teaching hospital. Participants: Thirty-three patients undergoing thoracoabdominal esophagecto my. Interventions:General anesthesia was combined with thoracic epidural anesth esia during surgery. The patients either continued with thoracic epidural a nalgesia [n = 18) or were switched to patient-controlled analgesia with int ravenous morphine (n = 15) for 5 postoperative days. Pain scores were estim ated twice daily, at rest and after mobilization. Peak expiratory flow forc ed expiratory volume, and vital capacity were measured the day before surge ry, postoperative day 2, and postoperative day 6. Adverse events and compli cations were recorded. Measurements and Main Results: At rest, there were no differences in pain r elief between the groups. Pain scores at mobilization showed a significantl y tower value in the epidural group (p<0.027). No intergroup differences we re found regarding pulmonary function, which decreased on postoperative day 2, but was improved on postoperative day 6. Conclusion: Continuation of intraoperative thoracic epidural anesthesia for 5 postoperative days provides better pain relief at mobilization compared with a switch to patient-controlled analgesia with intravenous morphine. Th ere was no intergroup difference in the impact on measures of pulmonary fun ction. Copyright (C) 2001 by W.B. Saunders Company.