Pain relief after esophagectomy:: Thoracic epidural analgesia is better than parenteral opioids

Objective: To compare postoperative pain relief and pulmonary function in patients after thoracoabdominal esophagectomy treated by continuing perioperative thoracic epidural anesthesia or changing to parenteral opioids. Design: Prospective, randomized study, Setting: University teaching hospital. Participants: Thirty-three patients undergoing thoracoabdominal esophagectomy. Interventions:General anesthesia was combined with thoracic epidural anesthesia during surgery. The patients either continued with thoracic epidural analgesia [n = 18) or were switched to patient-controlled analgesia with intravenous morphine (n = 15) for 5 postoperative days. Pain scores were estimated twice daily, at rest and after mobilization. Peak expiratory flow forced expiratory volume, and vital capacity were measured the day before surgery, postoperative day 2, and postoperative day 6. Adverse events and complications were recorded. Measurements and Main Results: At rest, there were no differences in pain relief between the groups. Pain scores at mobilization showed a significantly tower value in the epidural group (p<0.027). No intergroup differences were found regarding pulmonary function, which decreased on postoperative day 2, but was improved on postoperative day 6. Conclusion: Continuation of intraoperative thoracic epidural anesthesia for 5 postoperative days provides better pain relief at mobilization compared with a switch to patient-controlled analgesia with intravenous morphine. There was no intergroup difference in the impact on measures of pulmonary function. Copyright (C) 2001 by W.B. Saunders Company.