Epidural analgesia following thoracic surgery

Abstract

Key wordsPain; postoperative. Surgery; thoracic.The use of parenterally administered opiates as required in the conventional manner for postoperative pain relief has known disadvantages of which respiratory depression, nausea and vomiting, and inadequate pain relief are the most well recognised. In thoracic surgery in particular, any one of these disadvantages is potentially a major hazard. In an assessment of alternative methods of pain relief following thoracic operations over 60 patients in the authors' unit have had thoracic epidurals. The first two years' experience of the technique is pnsented. Method Paiieni seleciionNo specific guidelines were laid down for selection of patients for the study, but those with the accepted contraindications to the performance of an epidural block were excluded. Also excluded were patients with a history of cerebrovascular or cardiac disease whose condition could be compromised by the onset of hypotension which might be associated with

Continuous Perioperative Thoracic Epidural Fentanyl-Bupivacaine Infusion vs. Continuous Perioperative Fentanyl Intravenous Infusion in Patients Undergoing Major Upper Abdominal Cancer Surgeries

“…Fentanyl is more preferred than morphine as proved by a study conducted by Teng et al who concluded that patients receiving epidural fentanyl bupivacaine PCA experienced better overall pain relief, while morphine PCA, either epidural or intravenously, caused more side effects [17].…”

Early Removal of Urinary Catheter After Surgery Requiring Thoracic Epidural: A Prospective Trial

“…However, incidence of POUR has historically been high in the presence of thoracic epidurals. High-dose epidurals using bupivacaine 0.25% have been associated with POUR rates as high as 33% (21), while rates of less than 5% have been reported with lower doses (22). While the potentially harmful effects of bladder over-distention argue in favor of postoperative indwelling catheterization for the duration of epidural analgesic needs, the risk of CAUTI associated with prolonged catheterization makes a case for early catheter removal.…”

Thoracic epidural infusions for post thoracotomy pain relief: a clinical study to compare the efficacy of fentanyl — bupivicaine mixtures versus fentanyl alone

“…Thoracic epidural administration of bupivicaine, at least in high concentrations can produce excellent analgesia. However, the incidence of hypotension with 0.5% bupivicaine is high 3 and lower concentrations when used unsupplemented, are likely to be less effective.…”