Interpleural versus epidural analgesia with ropivacaine for postthoracotomy pain and respiratory function.

STUDY OBJECTIVE

To evaluate the impact of interpleural analgesia (IP) on postthoracotomy pain and respiratory function as an alternative to thoracic epidural analgesia (TEA).

DESIGN

Prospective, randomized study.

SETTING

Tertiary-care military hospital.

PATIENTS

Sixty young patients scheduled for elective thoracic surgery (correction of aorta coarctation and patent ductus arteriosus).

INTERVENTIONS

Patients were randomized into two groups to receive either IP or TEA for postthoracotomy pain management.

MEASUREMENTS

Patients in the IP group (n = 30) had a catheter inserted between the parietal and visceral pleura by a surgeon, and 0.2% ropivacaine was given through this catheter. In the TEA group, ropivacaine was administered through a thoracic epidural catheter. The impact of both methods on pain control, respiratory function, and pulmonary complications was analyzed and compared.

MAIN RESULTS

The frequency of atelectasis and pleural effusion was also significantly high in the IP group (P < 0.01). Respiratory function and postoperative pain scores were better in the TEA group (P < 0.01). Arterial blood gas analysis on the fifth postoperative day was significantly better in the TEA group.

CONCLUSION

Thoracic epidural analgesia has more beneficial effects on respiratory function and postoperative pain after thoracotomy than does IP.