Thoracic compared with lumbar epidural blocks for post-thoracotomy pain

Abstract

The aim of this study was to investigate whether thoracic epidural administration of a mixture of bupivacaine and fentanyl is superior to lumbar epidural administration for post-thoracotomy pain relief. After informed written consent had been obtained 81 patients who were scheduled for thoracotomy were randomly divided into two groups [group T (n = 50) and group L (n = 31)]. Epidural catheters were placed pre-operatively between the T4-T6 in group T and L1-L4 interspace in group L. At the end of the operation but before skin closure, 10 ml of a prepared solution containing bupivacaine 0.125 per cent and fentanyl 10 mcg/mi were given epidurally to both groups. Following the bolus injection, continuous infusion of the same solution was started at the rate of 6-8 ml/h in group L and 4-6 ml/h in group T. Blood pressure, heart rate, respiratory rate, sedation score, pain score by visual analogue scale and infusion rates were determined at the immediate post-operative period and at 2, 6, 24, 48 and 72 h post-operatively. There were no significant intergroup differences in heart rate, blood pressure, respiratory rate, and sedation score, while infusion and pain score diminished significantly (P < 0.001) in group T. In conclusion thoracic epidural bupivacaine-fentanyl produced much better analgesia than lumbar epidural administration for post-thoracotomy pain relief.