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; p0.05
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