ANALGESIA AFTER THORACOTOMY IN CHILDREN - A COMPARISON OF INTERPLEURAL, EPIDURAL, AND INTRAVENOUS ANALGESIA

The cohort for this study included 39 patients, between the ages of 8 and 20 years, who had had thoracotomy. Postoperative analgesia was provided by one of three techniques: intravenous narcotics (20 patients), thoracic epidural catheter (10 patients), or interpleural analgesia (IPA) (nine patients). Both IPA and epidural analgesia were administered according to a specific protocol. The efficacy of the three methods was evaluated using two indicators: the total intravenous narcotic requirements for the initial 72 hours and the number of times a dose of intravenous narcotic or supplemental epidural fentanyl was administered to each patient. Patients in the IPA group required significantly less intravenous narcotics (P < .05) during the first three postoperative days (2.2 +/- 0.4, 1.9 +/- 0.6, and 1.4 +/- 0.5 mg of meperidine/kg/day) than patients in the intravenous narcotic group (8.1 +/- 1.2, 7.2 +/- 0.9, and 5.6 +/- 1.2 mg of meperidine/kg/day). When comparing epidural analgesia and IPA, the number of interventions in the patients receiving epidural analgesia was significantly less (P < .05) than in the group receiving IPA. Four of 10 patients in the epidural group and two of nine in the IPA group required no interventions during the initial 72-hour postoperative course. In the epidural analgesia group, there were 19 days (of a total of 30 days) during which patients required no interventions. This percentage was significantly greater (P < .05) than that of the IPA group, in which there were 9 days (of a total of 27 days), during which no interventions were required.