Cardiothoracic and Vascular Anesthesia

A Randomized, Double-Blind Trial Comparing Continuous Thoracic Epidural Bupivacaine With and Without Opioid in Contrast to a Continuous Paravertebral Infusion of Bupivacaine for Post-thoracotomy Pain

Grider JS, Mullet TW, Saha SP, et al (Univ of Kentucky, Lexington) J Cardiothorac Vasc Anesth 26:83-89, 2012^§

Abstract

Objective

To compare the results of continuous epidural bupivacaine analgesia with and without hydromorphone to continuous paravertebral analgesia with bupivcaine in patients with post-thoracotomy pain.

Design

A prospective, randomized, double-blinded trial.

Setting

A teaching hospital.

Participants

Patients at a tertiary care teaching hospital undergoing throracotomy for lung cancer.

Interventions

Subjects were assigned randomly to receive a continuous thoracic epidural or paravertebral infusion. Patients in the epidural group were randomized to receive either bupivacaine alone or in combination with hydromorphone. Visual analog scores as well as incentive spirometery results were obtained before and after thoracotomy.

Methods and Main Results

Seventy-five consecutive patients presenting for thoracotomy were enrolled in this institutional review board–approved study. On the morning of surgery, subjects were randomized to either an epidural group receiving bupvicaine with and without hydromorphone or a paravertebral catheter–infused bupvicaine. Postoperative visual analog scores and incentive spirometry data were measured in the postanesthesia care unit, the evening of the first operative day, and daily thereafter until postoperative day 4. Analgesia on all postoperative days was superior in the thoracic epidural group receiving bupivacaine plus hydromorphone. Analgesia was similar in the epidural and continuous paravertebral groups receiving bupivacaine alone. No significant improvement was noted by combining the continuous infusion of bupivacaine via the paravertebral and epidural routes. Incentive spirometry goals were best achieved in the epidural bupivacaine and hydromorphone group and equal in the group receiving bupivacaine alone either via epidural or continuous paravertebral infusion.

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