Thoracic epidural and intrathecal analgesia have similar effects on pain relief and respiratory function after thoracic surgery

Purpose: To compare in a prospective randomized trial the effects of thoracic epidural infusions of fentanyl (F) and bupivacaine (B) to intrathecal morphine (M) and sufentanil (S) on analgesia and respiratory function following thoracotomy. Patients and methods. 55 patients undergoing on elective postero-lateral thoracotomy were randomly assigned to one of two groups: Group 1 (n = 2 7): received intrathecol S (5 mu g) and M (0.5 mg) one hour before surgery, Group 11 (n = 28) received, after induction of anesthesia, an initial dose of 10 to 20 mL of a solution of B 0.25% and F2 mu g(.)mL(-1) via an epidural thoracic catheter previously inserted between T5 and T8. The some solution was infused during surgery. After surgery, patients received a continuous infusion of B 0.1% and F 2 mu g(.)mL(-1) with a bolus every 15 min if needed. Heart rate (HR), mean arterial pressure (MAP), SpO(2), PacO(2), respiratory rate (RR), forced expiratory volume in one second, peak expiratory flow rote and forced vital capacity were recorded at different times from the day before surgery till T48 = 48 hr after surgery Subjective pain was assessed using a 10 cm visual analogue scale (VAS) scoring at rest and during cough. Results. No significant difference was noted between both groups concerning VAS, HR, MAP SpO(2), PacO(2), and RR. Variations of the respirotory function tests were identical in both groups, Conclusion: This study shows that intrathecal M and S offer analgesia comparable to thoracic epidurol infusion of B and F.