P. Flisberg et al., Pain relief after esophagectomy: Thoracic epidural analgesia is better than parenteral opioids, J CARDIOTHO, 15(3), 2001, pp. 282-287
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.