Thoracic epidural infusions for post-thoracotomy pain: a comparison of fentanyl–bupivacaine mixtures vs. fentanyl alone

✍ Scribed by S. V. Mahon; P. D. Berry; M. Jackson; G. N. Russell; S. H. Pennefather

• Publisher: John Wiley and Sons
• Year: 1999
• Tongue: English
• Weight: 95 KB
• Volume: 54
• Category: Article
• ISSN: 0003-2409
• DOI: 10.1046/j.1365-2044.1999.00856.x

✦ Synopsis

A randomised double‐blind clinical trial was conducted on 106 patients scheduled for pulmonary resection. Patients received an epidural infusion containing 0.1%, 0.2% bupivacaine or saline in combination with fentanyl 10 __μ__g.ml ^−1^. Adequacy of analgesia was assessed at rest and during movement over 24 h. Analgesic efficacy was assessed using visual analogue scores and an observer/verbal ranking scale. Pain scores were higher in the fentanyl‐only group at the 2 h assessment (p < 0.05). Otherwise, there were no between‐group differences in pain scores or in the total amounts of epidural solution used. All patients received continuous haemodynamic monitoring. There were no between‐group differences in the number of episodes of hypotension or in the number of interventions for hypotension. However, the use of intra‐operative vasopressor and the incidence of temporary neurological complications was higher in the 0.2% bupivacaine group (p < 0.05). We conclude that, in the early postoperative period, the addition of bupivacaine 0.1% improves fentanyl epidural analgesia in patients undergoing lung resection and is not associated with the disadvantages seen with the addition of bupivacaine 0.2%.