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

Flisberg, Per LU ; Törnebrandt, Kenneth; Walther, Bruno LU and Lundberg, Johan LU (2001) In Journal of Cardiothoracic and Vascular Anesthesia 15(3). p.282-287
Abstract
OBJECTIVE: To compare postoperative pain relief and pulmonary function in patients after thoracoabdominal esophagectomy treated by continuing perioperative thoracic epidural anesthesia or changing to parenteral opioids. DESIGN: Prospective, randomized study. SETTING: University teaching hospital. PARTICIPANTS: Thirty-three patients undergoing thoracoabdominal esophagectomy. INTERVENTIONS: General anesthesia was combined with thoracic epidural anesthesia during surgery. The patients either continued with thoracic epidural analgesia (n = 18) or were switched to patient-controlled analgesia with intravenous morphine (n = 15) for 5 postoperative days. Pain scores were estimated twice daily, at rest and after mobilization. Peak expiratory flow,... (More)
OBJECTIVE: To compare postoperative pain relief and pulmonary function in patients after thoracoabdominal esophagectomy treated by continuing perioperative thoracic epidural anesthesia or changing to parenteral opioids. DESIGN: Prospective, randomized study. SETTING: University teaching hospital. PARTICIPANTS: Thirty-three patients undergoing thoracoabdominal esophagectomy. INTERVENTIONS: General anesthesia was combined with thoracic epidural anesthesia during surgery. The patients either continued with thoracic epidural analgesia (n = 18) or were switched to patient-controlled analgesia with intravenous morphine (n = 15) for 5 postoperative days. Pain scores were estimated twice daily, at rest and after mobilization. Peak expiratory flow, forced expiratory volume, and vital capacity were measured the day before surgery, postoperative day 2, and postoperative day 6. Adverse events and complications were recorded. MEASUREMENTS AND MAIN RESULTS: At rest, there were no differences in pain relief between the groups. Pain scores at mobilization showed a significantly lower value in the epidural group (p < 0.027). No intergroup differences were 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. There was no intergroup difference in the impact on measures of pulmonary function. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
intravenous analgesia, thoracic epidural, esophagectomy, postoperative, morphine, bupivacaine
in
Journal of Cardiothoracic and Vascular Anesthesia
volume
15
issue
3
pages
282 - 287
publisher
W B Saunders
external identifiers
  • pmid:11426356
  • scopus:0034987741
ISSN
1532-8422
DOI
10.1053/jcan.2001.23270
language
English
LU publication?
yes
id
39370814-51e6-4faf-8fa8-54e1bdce7b76 (old id 1120200)
date added to LUP
2008-06-27 11:25:51
date last changed
2018-05-29 10:01:30
@article{39370814-51e6-4faf-8fa8-54e1bdce7b76,
  abstract     = {OBJECTIVE: To compare postoperative pain relief and pulmonary function in patients after thoracoabdominal esophagectomy treated by continuing perioperative thoracic epidural anesthesia or changing to parenteral opioids. DESIGN: Prospective, randomized study. SETTING: University teaching hospital. PARTICIPANTS: Thirty-three patients undergoing thoracoabdominal esophagectomy. INTERVENTIONS: General anesthesia was combined with thoracic epidural anesthesia during surgery. The patients either continued with thoracic epidural analgesia (n = 18) or were switched to patient-controlled analgesia with intravenous morphine (n = 15) for 5 postoperative days. Pain scores were estimated twice daily, at rest and after mobilization. Peak expiratory flow, forced expiratory volume, and vital capacity were measured the day before surgery, postoperative day 2, and postoperative day 6. Adverse events and complications were recorded. MEASUREMENTS AND MAIN RESULTS: At rest, there were no differences in pain relief between the groups. Pain scores at mobilization showed a significantly lower value in the epidural group (p &lt; 0.027). No intergroup differences were 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. There was no intergroup difference in the impact on measures of pulmonary function.},
  author       = {Flisberg, Per and Törnebrandt, Kenneth and Walther, Bruno and Lundberg, Johan},
  issn         = {1532-8422},
  keyword      = {intravenous analgesia,thoracic epidural,esophagectomy,postoperative,morphine,bupivacaine},
  language     = {eng},
  number       = {3},
  pages        = {282--287},
  publisher    = {W B Saunders},
  series       = {Journal of Cardiothoracic and Vascular Anesthesia},
  title        = {Pain relief after esophagectomy: Thoracic epidural analgesia is better than parenteral opioids},
  url          = {http://dx.doi.org/10.1053/jcan.2001.23270},
  volume       = {15},
  year         = {2001},
}