Pain outcomes after thoracotomy: lumbar epidural hydromorphone versus intrapleural bupivacaine.

OBJECTIVE

To evaluate postthoractomy analgesia in patients receiving lumbar epidural hydromorphone versus intrapleural bupivacaine.

DESIGN

A randomized, prospective, double-blind study.

SETTING

A university-affiliated medical center.

PARTICIPANTS

Twenty patients undergoing lateral thoracotomy for either pulmonary wedge resection, lobectomy, or pneumonectomy.

INTERVENTION: Nine patients received epidural hydromorphone, and 11 patients received intrapleural bupivacaine in the postoperative period.

MEASUREMENTS AND MAIN

RESULTS

Severity of pain was assessed using a visual analog pain scale (VAPS) (0 to 100 mm) at 1, 3, and 5 hours. Patients receiving epidural hydromorphone had a statistically significant improvement in VAPS scores. Patients who received intrapleural bupivacaine did not achieve a significant reduction in pain scores. Nine of 11 patients in the intrapleural bupivacaine group had "Ошибка" postoperative analgesia as defined by a VAPS greater than 30. Only 3 of 9 patients in the continuous epidural hydromorphone group had "Ошибка" analgesia.

CONCLUSION

Epidural hydromorphone is superior to intrapleural bupivacaine in achieving satisfactory pain outcomes during the first 5 hours after thoracotomy.