British Journal of Anaesthesia, Vol 76, Issue 1 72-76, Copyright © 1996 by The Board of Management and Trustees of the British Journal of Anaesthesia
J. L. Aguilar, R. Rincon, V. Domingo, P. Espachs, M. J. Preciado and F. Vidal
We have determined if thoracic extradural block before surgical incision
for thoracotomy produces pre-emptive analgesia. Using a double- blind,
placebo-controlled, crossover design, 45 patients (ASA II-III) undergoing
posterolateral thoracotomy for lung resection were randomized to one of
three groups: group 1 received 0.5% bupivacaine and adrenaline 1/200,000
(B+E) 8 ml through a thoracic extradural catheter (tip T3-T5) 30 min before
skin incision and saline 8 ml 15 min after skin incision; group 2 received
saline 8 ml extradurally before incision and B+E 8 ml after incision; group
3 received saline 8 ml extradurally before and after incision. General
anaesthesia was induced and maintained with propofol, alfentanil and
atracurium. The alfentanil infusion was stopped before chest closure and
fentanyl 50 micrograms in saline 10 ml was given extradurally.
Patient-controlled extradural analgesia (PCEA) was commenced with 0.125%
bupivacaine, adrenaline 1/400,000 and fentanyl 6 micrograms ml-1
(continuous rate of 2 ml h-1 and supplementary doses of 0.5 ml per 6 min).
Visual analogue scale (VAS) scores (recorded at rest, on mobilization and
after cough), verbal rating scale (VRS) (recorded at rest), number of
successful PCEA demands and complications were measured during the first 48
h after operation. There was no significant difference between groups,
either in PCEA requirements (P > 0.21) or in VAS scores (either at rest,
during mobilization of the ipsilateral arm of surgery or after cough). No
significant differences between groups were found in the VRS. Thoracic
extradural block with bupivacaine did not produce an early preemptive
effect after thoracotomy.
CLINICAL INVESTIGATIONS
Absence of an early pre-emptive effect after thoracic extradural bupivacaine in thoracic surgery
Department of Anaesthesiology, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
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