Post-operative analgesia by epidural versus intramuscular nicomorphine after thoracotomy. Part II

One hundred and sixty-three patients subjected to three different types of thoracic operation were allocated randomly either to balanced intravenous anaesthesia including i.v. opiates with post-operative intramuscular opiates (intramuscular group) or to balanced intravenous anaesthesia without i.v. opiates but with high thoracic epidural regional block during the operation as well as epidural nicomorphine post-operatively (epidural group). Post-operative nicomorphine in either group was given only at the request of the patient and as frequently as needed to obtain satisfactory pain relief. Patients in the epidural group were given nicomorphine exclusively by epidural injection. Patients in the epidural group required significantly less nicomorphine for effective pain relief (29 mg (sd = 10) over a period of 3 days compared to 52 mg (sd = 27) in the intramuscular group. Significantly fewer pulmonary complications in the epidural group were observed (9 atelectases in 83 patients in the epidural group compared to 24 atelectases in 80 patients in the intramuscular group). Only one patient developed pneumonia (intramuscular group). Although the epidural catheter was inserted at the T3-T4 level, no signs of ventilatory depression were found; on the contrary, respiration in the epidural group was significantly better than the intramuscular group. None of the patients, in either analgesia group, needed to be ventilated post-operatively.