Yegin Arif, Erdogan Abdullah, Kayacan Nurten, Karsli Bilge
Department of Anaesthesiology, Akdeniz University Medical Faculty, Antalya, Turkey.
Eur J Cardiothorac Surg. 2003 Sep;24(3):420-4. doi: 10.1016/s1010-7940(03)00345-2.
Effective analgesia and blockade of the perioperative stress response may improve outcome and epidural analgesia plays a role in the reduction of pulmonary complications following thoracic surgery. In this study, we assessed preoperative and postoperative thoracic epidural analgesia (Preop-TEA and Postop-TEA) techniques on post-thoracotomy pain in 61 patients undergoing posterolateral thoracotomy.
A thoracic epidural catheter was inserted into all the patients before surgery. In Group I, 8 mL of 0.25% bupivacaine plus fentanyl 50 microg in 2 mL was administered preoperatively. In Group II, no medication was administered via the epidural catheter preoperatively and intraoperatively. Postoperative analgesia was maintained with patient-controlled epidural analgesia with bupivacaine and fentanyl solution in both groups. Pain was evaluated at 2, 4, 8, 12, 24 and 48 h at rest and coughing.
Preop-TEA Group was associated with decreased pain compared with the Postop-TEA Group.
In conclusion, preoperative epidural analgesia is an appropriate method for post-thoracotomy pain and is more effective in preventing acute postoperative pain.
有效的镇痛以及围手术期应激反应的阻滞可能会改善预后，并且硬膜外镇痛在减少胸科手术后肺部并发症方面发挥作用。在本研究中，我们评估了61例行后外侧开胸手术患者术前和术后胸段硬膜外镇痛（Preop-TEA和Postop-TEA）技术对开胸术后疼痛的影响。
所有患者在手术前均插入胸段硬膜外导管。I组术前给予8 mL含2 mL中50 μg芬太尼的0.25%布比卡因。II组术前和术中未通过硬膜外导管给药。两组术后均采用布比卡因和芬太尼溶液的患者自控硬膜外镇痛维持镇痛。在静息和咳嗽状态下于2、4、8、12、24和48小时评估疼痛情况。
与Postop-TEA组相比，Preop-TEA组疼痛减轻。
总之，术前硬膜外镇痛是开胸术后疼痛的一种合适方法，在预防术后急性疼痛方面更有效。
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