Post-thoracotomy pain relief with subpleural analgesia or thoracic epidural analgesia: randomized clinical trial

ABSTRACT CONTEXT AND OBJECTIVE: Post-thoracotomy pain is a severe and intense pain caused by trauma to ribs, muscles and peripheral nerves. The current study aimed to compare subpleural analgesia (SPA) with thoracic epidural analgesia (TEA) in patients undergoing thoracotomy. DESIGN AND SETTING: Randomized study at Ankara Numune Education and Research Hospital, in Turkey. METHODS: Thirty patients presenting American Society of Anesthesiologists physical status I-III were scheduled for elective diagnostic thoracotomy. The patients were randomized to receive either patient-controlled SPA or patient-controlled TEA for post-thoracotomy pain control over a 24-hour period. The two groups received a mixture of 3 µg/ml fentanyl along with 0.05% bupivacaine solution through a patient-controlled analgesia pump. Rescue analgesia was administered intravenously, consisting of 100 mg tramadol in both groups. A visual analogue scale was used to assess pain at rest and during coughing over the course of 24 hours postoperatively. RESULTS: In the SPA group, all the patients required rescue analgesia, and five patients (33%) required rescue analgesia in the TEA group (P【背景与目的】开胸术后疼痛是因肋骨、肌肉及周围神经损伤引发的剧烈疼痛。本研究旨在对比胸膜下镇痛（subpleural analgesia, SPA）与胸段硬膜外镇痛（thoracic epidural analgesia, TEA）在接受开胸手术患者中的应用效果。 【研究设计与研究地点】本研究为在土耳其安卡拉努内科教育与研究医院开展的随机研究。 【研究方法】纳入美国麻醉医师协会（American Society of Anesthesiologists, ASA）体格状态分级I~III级的30例择期诊断性开胸手术患者。将患者随机分为两组，分别采用患者自控胸膜下镇痛或患者自控胸段硬膜外镇痛，于术后24小时内管控开胸术后疼痛。两组均通过患者自控镇痛泵输注3μg/ml芬太尼与0.05%布比卡因混合液。两组均经静脉给予补救镇痛药物，剂量为100mg曲马多。于术后24小时内，采用视觉模拟评分法（visual analogue scale, VAS）评估患者静息状态及咳嗽时的疼痛程度。 【研究结果】胸膜下镇痛组所有患者均需接受补救镇痛，胸段硬膜外镇痛组有5例患者（33%）需接受补救镇痛（P