Thoracic epidural for post-thoracotomy pain: a comparison of three concentrations of sufentanil in bupivacaine

ABSTRACT. Background:The aim of this prospective, double blind, randomised trial was to compare the analgesic and adverse effectsof three concentrations of the thoracic epidural sufentanil with bupivacaine in patients undergoing thoracotomy.Methods:We studied 60 (randomised) patients who were to receive a 10 ml bolus dose of sufentanil, 1µg/ml, 2 µg/ml and3 µg/ml, in bupivacaine 0.125%, via thoracic epidural. Postoperatively, pain at rest, on coughing and with ambulation wasassessed using a visual analogue scale (VAS) and observer verbal ranking score (OVRS) at 2, 6, 12 and 24 hours. Adverseeffects were simultaneously assessed.Results:There was no significant difference in the baseline characteristics between the three groups. The number of patientswith episodes of unsatisfactory pain, i.e. a VAS scores ≥ 40 and OVRS ≥ 2, at each of the four assessments postoperatively,was significantly higher with sufentanil 1 g/ml than with sufentanil 2 µg/ml or µ3 g/ml (p < 0.05). In the 3 µg/ml sufentanilgroup, four patients (20%) had a sedation score ≥ 3 compared with one (5%) and no (0%) patients in the 2 µg/ml and1 µg/ml sufentanil groups, respectively (p < 0.05). In addition, 30% patients experienced pruritus in the 3 µg/ml sufentanilgroup compared with 10% and 5%, respectively, in the 2 µg/ml and 1 µg/ml sufentanil groups. In the sufentanil 3 µg/ml,2 µg/ml and 1 µg/ml groups, 30%, 20% and 5% patients, respectively, had emetics symptoms (p < 0.05).Conclusions:We conclude that a thoracic epidural bolus of 10 ml sufentanil 2 µg/ml with bupivacaine 0.125% provides theoptimal balance between pain relief and side-effects following thoracotomy

A prospective, randomised comparison of continuous paravertebral block and continuous intercostal nerve block for post-thoracotomy pain

ABSTRACTBackground: This study aimed to compare paravertebral block and continuous intercostal nerve block after thoracotomy.Methods: Forty-six adult patients undergoing elective posterolateral thoracotomy were randomised to receive either acontinuous intercostal nerve blockade or a paravertebral block. Opioid consumption and postoperative pain were assessedfor 48 hours .Pulmonary function was assessed by forced expiratory volume in 1 s (FEV1) recorded at 4 hours intervals.Results: With respect to the objective visual assessment (VAS), both techniques were effective for post thoracotomy pain.The average VAS score at rest was 29±10mm for paravertebral block and 31.5±11mm for continuous intercostal nerve block.The average VAS score on coughing was 36±14mm for the first one and 4 ±14mm for the second group.Pain at rest was similar in both groups. Pain scores on coughing were lower in paravertebral block group at 42 and 48hours. Post-thoracotomy function was better preserved with paravertebral block. No difference was found among the twogroups for side effects related to technique, major morbidity or duration of hospitalisation.Conclusion: We found that continuous intercostal nerve block and paravertebral block were effective and safe methods forpost-thoracotomy pain

Review of 322 cases of ductal surgery: Enugu experience

The Enugu experience of surgical treatment for persistent patency of the ductus arteriosus (PDA) over the period April 1986 to March 1992 is reviewed. A total of 322 patients with PDA had left thoracotomy. Ligation alone was carried out in six patients (1;86 per cent); division and suture closure was done in 312 (96;89 per cent); while in 4 patients (1;24 per cent); the PDA was not closed because of the presence of severe pulmonary hypertension and right to left shunting at the ductal level. The commonest associated anomaly was ventricular septal defect requiring pulmonary artery banding in addition to ductal closure in 59 patients (18;30 per cent). There were 2 deaths in the series (0;62) with occured in neonates with other malformation. It is concluded that operative closure of PDA is a safe procedure