BJA Advance Access originally published online on March 19, 2004
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British Journal of Anaesthesia, 2004, Vol. 92, No. 5 670-674
© 2004 The Board of Management and Trustees of the British Journal of Anaesthesia
Optimal concentration of epidural fentanyl in bupivacaine 0.1% after thoracotomy
Department of Anaesthesia, The Cardiothoracic Centre, Liverpool, Thomas Drive, Liverpool L14 3PE, UK 1 Present address: Department of Anaesthesia, University Hospitals of Wales, Heath Park, Cardiff CF14 4WX, UK 2 Present address: Department of Anaesthesia, University Hospital Aintree, Longmoor Lane, Liverpool L9 7A, UK
*Corresponding author. E-mail: stephen.pennefather{at}ctc.nhs.uk
Background. The aim of this prospective, double-blind, randomized controlled trial was to investigate the analgesic and adverse effects of three commonly used concentrations of thoracic epidural fentanyl with bupivacaine in patients undergoing thoracotomy for lung resection.
Methods. We studied 99 patients who were randomized to receive fentanyl 2 µg ml–1 (group 2), fentanyl 5 µg ml–1 (group 5) and fentanyl 10 µg ml–1 (group 10) in bupivacaine 0.1% via a thoracic epidural. Postoperatively, pain on coughing was assessed using a visual analogue scale (VAS) and an observer verbal rating score (OVRS) at 2, 8, 16 and 24 h. At the same times, sedation, pruritus and nausea were assessed.
Results. Of 29, 28 and 32 patients who completed the study in groups 2, 5 and 10 respectively, there was no significant difference in baseline characteristics between the three groups. The number of patients with episodes of unsatisfactory pain, i.e. VAS scores >30 mm and OVRS >1, at each of the four assessments postoperatively was significantly (P<0.01) higher in group 2 than in groups 5 and 10. In group 10, 16 patients had sedation scores >1 compared with 10 each in groups 2 and 5. In addition, 19 patients in group 10 experienced pruritus compared with 12 each, in groups 2 and 5. These differences were not significant. Nausea was not significantly different between the three groups.
Conclusion. We conclude that thoracic epidural fentanyl 5 µg ml–1 with bupivacaine 0.1% provides the optimum balance between pain relief and side effects following thoracotomy.
Br J Anaesth 2004: 92: 670–4
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