The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

Comparison of thoracic epidural or paravertebral analgesia on pulmonary function after lung surgery

Novak Jankovič Vesna MD PhD. Clinical department of anesthesiology and intensive therapy, University medical centre. Slovenia,Europe

Background: Lung surgery causes severe post-thoracotomy pain with its associated pathophysiological abnormalities. In prospective, randomized study the influence of two different analgesic techniques on the postoperative pulmonary function in patients undergoing lung surgery were studied.

Methods:
After the approval from the institutional ethics committee 20 patients (ASA II-III) were randomly allocated to two groups. In thoracic epidural group (TEA) epidural cathether was placed between T6-T7;in the paravertebral group(PVB) the cathether were placed at T6-T7 in the paravertebral space(ipsilateral to the thoracotomy)..In both groups preoperatively, 4 mg of morphine and 5mL of 0.5% bupivacaine were injected through the catheter.Infusion of analgesic mixture ( 10 mg of morphine,50mg of bupivacaine and 0.15 mg of clonidine in 100 mL of saline)were given postoperatively for patient controlled analgesia at the rate of 1mL/h, bolus dose 3mL and lock out period of 30 min. Spirometric measurements FVC,FEV1,maximal inspiratory pressure(MIP)and maximal exspiratory pressure(MEP)were performed preoperatively and 3 days postoperatively. The data were analysed by the ANOVA test; p0.05 were considered significant.

Results:
No statistically significant differences in values of spirometric measurements were noted between the two groups at any time(table 1.).

Table 1.Mean values of spirometric measurements

Time 0 0 1 1 2 2 3 3
Group TEA PVB TEA PVB TEA PVB TEA PVB
FVC(L) 3.18 3.28 1.76 1.82 1.93 1.98 1.99 2.01
FEV1 2.13 2.28 1.28 1.32 1.38 1.41 1.37 1.49
MIP(-cmH2O) 54.98 53.42 43.52 39.30 47.99 43.50 48.10 46.00
MEP(cmH2O) 56.53 55.35 48.89 48.70 54.62 52.01 54.90 57.01

0- preoperatively;1-1st postop.day;2-2nd postop.day;3-3rd postop.day

Conclusion: PVB is as effective as TEA for preservation of pulmonary function after lung surgery. We recommend PVB because it is tecnically easier and safer than TEA(1)

Reference: J.Richardson et al. Br J Anaesth 1999; 83(3):387-92

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