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Pain outcomes after thoracotomy: lumbar epidural hydromorphone versus intrapleural bupivacaine
R R Gaeta1, A Macario, J B Brodsky
1Department of Anesthesiology, Stanford University School of Medicine, Palo Alto, CA 94305-5115, USA.
Objective:
To evaluate postthoractomy analgesia in patients receiving lumbar epidural hydromorphone versus intrapleural bupivacaine.
Design:
A randomized, prospective, double-blind study.
Setting:
A university-affiliated medical center.
Participants:
Twenty patients undergoing lateral thoracotomy for either pulmonary wedge resection, lobectomy, or pneumonectomy.
Intervention:
Nine patients received epidural hydromorphone, and 11 patients received intrapleural bupivacaine in the postoperative period.
Measurements And Main Results:
Severity of pain was assessed using a visual analog pain scale (VAPS) (0 to 100 mm) at 1, 3, and 5 hours. Patients receiving epidural hydromorphone had a statistically significant improvement in VAPS scores. Patients who received intrapleural bupivacaine did not achieve a significant reduction in pain scores. Nine of 11 patients in the intrapleural bupivacaine group had "failed" postoperative analgesia as defined by a VAPS greater than 30. Only 3 of 9 patients in the continuous epidural hydromorphone group had "failed" analgesia.
Conclusion:
Epidural hydromorphone is superior to intrapleural bupivacaine in achieving satisfactory pain outcomes during the first 5 hours after thoracotomy.