Effects of epidural morphine and levobupivacaine combination before incision and after incision and in the postoperative period on thoracotomy pain and stress response

Abstract

Background/aim: This study aims to investigate the effects of thoracic epidural analgesia, before and after surgical incision and in the postoperative period, on thoracotomy pain and stress response. Materials and methods:A total of 45 patients who were scheduled for posterolateral thoracotomy were included in this study. A combination of epidural levobupivacaine and morphine was administered as a bolus before incision (Group 1; n=15), after incision (Group 2; n=15), or at the end of surgery (Group 3; n=15). Additionally, infusion was used in Group 1 and Group 2 during operation. Postoperative patient-controlled epidural analgesia infusion pumps were connected to all patients. Visual analog scale (VAS) scores and morphine consumption were recorded during the postoperative 48 h. Glucose, insulin, cortisol, and C-reactive protein (CRP) levels were compared before surgery and at 4, 24, and 48 h after the operation.Results: There were no differences in the morphine consumption and VAS scores for all measurements among the groups (P > 0.05). Both blood glucose levels at 4 h and CRP values at 48 h were higher in Group 2 than Group 1 (P < 0.05). Cortisol levels at 4, 24, and 48 h after the operation were similar to baseline values in all groups (P > 0.05). Conclusion:The application of thoracic epidural analgesia before and after surgical incision and in the postoperative period did not result in a significant difference in the severity of the postthoracotomy pain and stress response in all groups. Based on our results, we suggest that epidural levobupivacaine combined with morphine provides an effective and safe analgesia and can partially suppress surgical stress response.

The Effectiveness of Active External Warming of Patient Concurrently With Ice Application on the Incision Site on Post-Thoracotomy Pain and Analgesic Consumption

“…Patients in whom hemodynamic stabilization was not achieved 2 hours after thoracotomy, patients with Raynaud’s phenomenon, neuropathy, or peripheric vascular disease, patients who underwent postoperative procedures that directly affect pain levels, such as decortication and thoracic wall resection, patients who received preemptive analgesia for pain control, and patients who received analgesia through pleural, thoracal, and other catheter methods were excluded from the study. Preemptive analgesia refers to the use of analgesic methods before surgical incision or stimulation to change the perception of harmful stimulation by the peripheral and central nervous systems to reduce central sensitization, hyperalgesia, and touch-induced pain (Barut et al, 2018; Kong et al, 2020; Yakşi & Yakşi, 2017). Routine analgesic treatment applied in the first 2 hours of the postoperative period in the ICU was not considered to be within the scope of preemptive treatment.…”

Recent Advances in Electroanalysis Techniques Used for Morphine in Managing Postoperative Pain

“…The off-label use of morphine is common for practically any painful disease. When patients in the emergency room do not respond to first-and second-line medications for musculoskeletal pain, stomach discomfort, chest pain, arthritis, and even migraines, morphine is administered [11].…”

Application of stem cells and exosomes in the treatment of intracerebral hemorrhage: an update

“…In 1981, pluripotent ESCs were first extracted from in vitro mouse blastocysts [ 23 ]. These cells are highly undifferentiated and can self-renew, reproduce indefinitely, mature, and differentiate into any cell, including nerve cells [ 35 , 36 ]. In 1995, ESCs were extracted from primates [ 37 ] and 3 years later from human cell lines.…”