Pain following thoracotomy. A randomised, double-blind comparison of lumbar versus thoracic epidural fentanyl

Fifty-eight patients scheduled for elective thoracotomy were randomly allocated to receive fentanyl by either the thoracic or the lumbar epidural route for postoperative analgesia. The infusion rate was adjusted to optimise analgesia. Dose adjustment, pain assessment and the incidence of side effects were monitored by a blinded observer at set times over the 24 hour study period. Similar pain scores were obtained in both groups at all assessment times. In addition, there was no significant difference in dose requirements or incidence of side effects between the two groups. There appears little justification for the use of the generally less familiar, and potentially more dangerous, thoracic approach when fentanyl alone is infused into the epidural space following thoracotomy.