COMPARISON OF EPIDURAL ANALGESIA AND CRYOANALGESIA IN THORACIC-SURGERY

被引：33

作者：

BRICHON, PY

PISON, C

CHAFFANJON, P

FAYOT, P

BUCHBERGER, M

NERON, L

BOCCA, A

VERDIER, J

SARRAZIN, R

机构：

[1] Department of Thoracic Surgery, Hôpital A. Michallon, F-38700, La Tronche

[2] Department of Respiratory Medicine, Hôpital A. Michallon, F-38700, La Tronche

[3] Department of Anesthesiology, Hôpital A. Michallon, F-38700, La Tronche

[4] Centre d’Etudes Nucléaires de Grenoble, Grenoble

来源：

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY | 1994年 / 8卷 / 09期

关键词：

THORACOTOMY; PAIN; CRYOANALGESIA; EPIDURAL ANALGESIA;

D O I：

10.1016/1010-7940(94)90019-1

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

A prospective study was carried out in 120 patients undergoing elective thoracotomy for parenchymal disease. Patients were randomized into three groups: A (control group), B (epidural analgesia), C (freezing of intercostal nerves). Subjective pain relief was assessed on a linear visual analog scale. Analgesic requirements were evaluated during the 12 days following surgery, or until discharge if earlier. The vital capacity (VC) and forced expiratory volume in 1 s (FEV1) were measured on the day before operation and on the 1st, 2nd, 3rd and 7th postoperative days (POD). Subjective pain relief was significantly better in Group B in comparison with Group A (P < 0.05) or C (P < 0.05). Group C had the lowest score on the 11th and 12th POD but differences were not statistically significant. Requirements for intravenous analgesics were lower in Group B than in the control group (P < 0.05) during the first 3 POD, and in group C than in the control group the day of operation (P < 0.05). Oral analgesic requirements, when compared with controls, were lower in group B during the first 5 POD, and lower in group C on the 3rd and the 4th POD (P < 0.05). Cryoanalgesia led to a slight but not significant increase in VC and FEV1. Epidural analgesia led to a significant increase when compared with controls in FEV1 during the first 3 POD, and in FVC on the 7th POD (P < 0.05). It is concluded that epidural analgesia led to the best pain relief and restoration of pulmonary function after thoracotomy. Cryoanalgesia seemed to be effective for pain relief, but a few days later than the former.

引用

页码：482 / 486

页数：5

共 21 条

[11]

James B.C., Kolberg H.L., Iwen J.W., Gellatly T.A., Epidural analgesia for post thoracotomy patients, J Thorac Cardiovasc Surg, 82, pp. 898-903, (1981)

[12]

Katz J., Nelson W., Forest R., Bruce D.L., Cryoanalgesia for post thoracotomy pain, Lancet, 1, pp. 512-513, (1980)

[13]

Loan W.B., Dundee J.W., The clinical assessment of pain, Practitioner, 198, pp. 759-768, (1967)

[14]

Maiwand M.O., Makey A.R., Rees A., Cryoanalgesia after thoracotomy. Improvement of technique and review of 600 cases, J Thorac Cardiovasc Surg, 92, (1986)

[15]

Mourisse J., Hasenbos M.A.W.M., Gielen M.J.M., Moll J.E., Crom-Heecke G.J.E., Epidural bupi vacaine, sufentanil or the combination for post-thoracotomy pain, Acta Anaesthesiol Scand, 36, pp. 70-74, (1992)

[16]

Olivet R.T., Nauss L.E., Payne W.S., A technique for continuous intercostal nerve block analgesia following thoracotomy, J Thorac Cardiovasc Surg, 80, pp. 308-313, (1980)

[17]

Orr I.A., Keenan D.J.M., Dundee J.W., Patterson C.C., Greenfield A.A., Post-thoracotomy pain relief: Combined use of cryoprobe and morphine infusion techniques, Ann R Coll Surg Engl, 65, pp. 366-369, (1983)

[18]

Sabanathan S., Mearns A.J., Bickford Smith P.J., Bibby S.R., Majid M.R., Efficacy of continuous extrapleural intercostal nerve block on post-thoracotomy pain and pulmonary mechanics, Brj Surg, 77, pp. 221-225, (1990)

[19]

Shafei H., Chamberlain M., Natrajan K.N., Khan M.A.R., Gandhi R.G., Intrapleural bupivacaine for early post-thoracotomy analgesia-Comparison with bupivacaine intercostal block and cryofreezing, Thorac Cardiovasc Surg, 38, pp. 38-41, (1990)

[20]

Shulman M., Sandler A.N., Bradley J.W., Young P.S., Brebner J., Post thoracotomy pain and pulmonary function following epidural and systemic morphine, Anesthesiology, 61, (1984)

← 1 2 3 →