Comparison of General Anesthesia and Thoracic Epidural Anesthesia for Breast Mass Excision Surgery / 대한마취과학회지

BACKGROUND: The purpose of this study is to compare the effectiveness of thoracic epidural anesthesia (TEA) and general anesthesia (GA) in terms of side effects, postoperative pain control and the cost of anesthesia for breast mass excision surgery. METHODS: Forty-three patients rated as ASA physical status class 1 or 2 who underwent breast mass excision surgery were included in the study. In the TEA group (n = 20), 2% lidocaine (3 ml) and 0.5% bupivacaine (3 ml) were administered via the epidural route. Blood pressure and heart rate were measured before and at 3, 6, 9, 12, 15, 18 21, 24, 27 and 30 minutes after epidural injection. In the GA group (n = 23) patients were maintained by general anesthesia with enflurane and 50% nitrous oxide in oxygen. After the operation, patients were given NSAID-diclofenac sodium as they wanted. Analgesic requirement, satisfaction score, and anesthesia-related side effects were recorded 1 day after surgery. Satisfaction scores of the surgeons and patients were recorded as excellent (4 point), good (3 point), fair (2 point), and unacceptable (1 point). RESULTS: Overall satisfaction scores and side effects were not significantly different between the TEA group and the GA group. Anesthesia cost (80,883.2 +/- 3956.9 vs 32,284.8 +/- 1209.4 won) were significantly lower in the TEA group than in the GA group. CONCLUSIONS: There were not significant differences in satisfaction scores and postoperative side effests between the TEA and GA groups. TEA provided lower anesthesia cost than GA for breast mass excision surgery.

The Comparison of Epidural Analgesia with Fentanyl by the Lumbar Versus Thoracic Route after Thoracotomy / 대한마취과학회지

BACKGROUND: Epidural analgesia, via either a thoracic or lumbar route, is commonly used to provide postoperative analgesia following thoracotomy for pulmonary resection, but little data indicate which location is better in terms of postoperative analgesia, side effects, or associated complications. METHODS: 54 patients, who undergo a lateral thoracotomy, were randomized to receive a mixture of fentanyl and 0.15% bupivacaine at 0.5microgram/kg/hr of fentanyl via either a thoracic (Group T) or a lumbar (Group L) catheter. Postoperative pain was assessed 6hrs after the operation and everyday for 5 days on a visual analog scale (VAS). Postoperative side effects and patients satisfaction of epidural analgesia were assessed by 4 grades system. RESULTS: The VAS scores during coughing were higher than those of resting state without intergroup differences. The incidences and severity of side effects (nausea, vomiting, pruritus, sedation) were not different between group T and group L, but the incidence of urinary retention attributable to use of the lumbar epidural route was significantly higher than with the thoracic route (p<0.05). CONCLUSIONS: The authors conclude that there is no clinical advantage of thoracic over lumbar epidural fentanyl in the thoracotomy patients with respect to analgesia and incidences of most side effects except urinary retention.