Effects of preoperatively or postoperatively initiated thoracic epidural analgesia in patients undergoing elective lung surgery

Abstract

Objective: The goal of this study was to investigate the effects of preoperatively and postoperatively initiated thoracic epidural analgesia (TEA) on oxidative stress, respiratory functions and postoperative pain in patients undergoing elective lung surgery. Material and Methods: A thoracic epidural catheter was inserted into all the patients before surgery. In Preop- TEA Group (n= 15), bolus dose of 0.175% bupivacaine and 15 μg ml1 fentanyl (0.1 ml kg-1) were administered preoperatively, followed by a continuous infusion of 0.125% bupivacaine and 10μg ml1 fentanyl combination (0.1 ml kg 1 h_1) intra-operatively. In Postop- TEA Group (n= 15), no medication was administered via the epidural catheter preoperatively. Postoperative analgesia was maintained with patient-controlled epidural analgesia (PCA) in both groups for 48 h. We assessed peroperative IV analgesic requirtment and postoperative pain and analgesic consumption, oxidative stress, heart rate, blood pressure, respiratory functions and side effects. The postoperative intensive care unit and hospital stay durations were recorded. Student's t-test, κ2-test, Mann-Whitney U test, and Wilcoxon's signed rank test were used for group comparisons and statistical conclusions. Results: Visual analogue scores were always higher during coughing and at rest, perioperative heart rate was increased in Postop-TEA Group (p< 0.05). Total peroperative fentanyl requirement and postoperative analgesic consumption via PCA were lower in Preop- TEA Group (p< 0.05). Respiratory function tests were decreased in both groups when compared to the preoperative values (p< 0.05), but the differences were small in Preop-TEA group (p< 0.05). No marked effect on oxidative stress was determined and shorter length of stay in ICU and hospital shorter in Preop-TEA Group (p< 0.05). Conclusion: These results suggest that preoperatively initiated TEA provides better postoperative pain relief with improving the outcome and shortening intensive care and hospital stay in patients undergoing elective lung surgery. However, TEA had no marked effect on oxidative stress in our study. © 2010 by Türkiye Klinikleri.