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Administration of epidural bupivacaine combined with epidural morphine after esophageal surgery
LITERATURE REVIEW
492
POSTOPERATIVE PAIN MANAGEMENT FOR THORACIC SURGERY
Terai T, Yukioka H, Fujimori M: Administration of epidural bupivacaine combined with epidural morphine after esophageal surgery. Surgery 121:359-365, 1997 Early tracheal extubation after esophagectomy may reduce complications and health care costs. This randomized double-blind trial studied 20 patients undergoing esophagectomy through a thoracoabdominal approach. All patients received epidural morphine at wound closure, and then either 0.25% bupivacaine infusion (n = 10) or saline (n = 10) for 16 hours. The time to extubation was 4.4 (6.7) hours and 13.7 (7.1) hours, respectively (p < 0.05). There were no significant differences in pain scores, respiratory rate, or hemodynamic changes, and all patients reported adequate pain relief. This small study suggests that a combination of epidural morphine and bupivacaine infusion may be better than morphine alone in reducing time to extubation after esophagectomy.
Benedetti F, Amanzio M, Casadio C, et al: Control of postoperative pain by transcutaneous electrical nerve stimulation after thoracic operations. Ann Thorac Surg 63:773-776, 1997 Studies have reported variable success using transcutaneous electrical nerve stimulation (TENS) to control postoperative pain. This study stratified patients according to extent of thoracic surgery, and the patients were then randomized to receive TENS, placebo TENS, or control. TENS was not more effective than placebo TENS or control in patients undergoing posterolateral thoracotomy, but was somewhat more effective in patients undergoing limited thoracotomies. TENS was
very effective in patients undergoing video-assisted thoracoscopy. Although there were some deficiencies in this study, and the cost of TENS was not adequately considered, there may be some merit in considering TENS for some thoracic surgical patients.
Hendriks GW, Hasenbos MA, Gielen M J, et ah Evaluation of thoracic epidural catheter position and migration using radio-opaque catheters. Anaesthesia 52:457-459, 1997 Displacement and migration of epidural catheters continue to be a problem in perioperative pain management. Migration of T3-4 thoracic epidural catheters was monitored in 25 thoracic surgery patients using daily chest radiograph for 3 days. There was no change in position in those patients who underwent surgery in the supine position, but there was some retraction in those who underwent surgery in the lateral position: day 1, 0.69 (1.1) cm; day 2, 0.35 (0.67) cm; p < 0.05. Nine (39%) catheters were found to be unintentionally directed cephalad. Chest radiograph appears to be a simple method of monitoring epidural catheter position. The factors responsible for catheter migration have yet to be adequately determined. ACKNOWLEDGMENT
Papers reviewed in this issue were selected from those published in the following journals: American Heart Journal, American Journal of
Cardiology, Anaesthesia, Annals of Thoracic Surgery, Journal of American College of Cardiology, Journal of Vascular Surgery, New England Journal of Medicine, and Vascular Surgery. Contributions to this section were made by Dr Paul Myles, Department of Anaesthesiology and Pain Management, Alfred Hospital, Prahran, Victoria, Australia, and Dr David Moskowitz, Department of Anesthesiology, Mount Sinai Hospital, New York, NY.
492
POSTOPERATIVE PAIN MANAGEMENT FOR THORACIC SURGERY
Terai T, Yukioka H, Fujimori M: Administration of epidural bupivacaine combined with epidural morphine after esophageal surgery. Surgery 121:359-365, 1997 Early tracheal extubation after esophagectomy may reduce complications and health care costs. This randomized double-blind trial studied 20 patients undergoing esophagectomy through a thoracoabdominal approach. All patients received epidural morphine at wound closure, and then either 0.25% bupivacaine infusion (n = 10) or saline (n = 10) for 16 hours. The time to extubation was 4.4 (6.7) hours and 13.7 (7.1) hours, respectively (p < 0.05). There were no significant differences in pain scores, respiratory rate, or hemodynamic changes, and all patients reported adequate pain relief. This small study suggests that a combination of epidural morphine and bupivacaine infusion may be better than morphine alone in reducing time to extubation after esophagectomy.
Benedetti F, Amanzio M, Casadio C, et al: Control of postoperative pain by transcutaneous electrical nerve stimulation after thoracic operations. Ann Thorac Surg 63:773-776, 1997 Studies have reported variable success using transcutaneous electrical nerve stimulation (TENS) to control postoperative pain. This study stratified patients according to extent of thoracic surgery, and the patients were then randomized to receive TENS, placebo TENS, or control. TENS was not more effective than placebo TENS or control in patients undergoing posterolateral thoracotomy, but was somewhat more effective in patients undergoing limited thoracotomies. TENS was
very effective in patients undergoing video-assisted thoracoscopy. Although there were some deficiencies in this study, and the cost of TENS was not adequately considered, there may be some merit in considering TENS for some thoracic surgical patients.
Hendriks GW, Hasenbos MA, Gielen M J, et ah Evaluation of thoracic epidural catheter position and migration using radio-opaque catheters. Anaesthesia 52:457-459, 1997 Displacement and migration of epidural catheters continue to be a problem in perioperative pain management. Migration of T3-4 thoracic epidural catheters was monitored in 25 thoracic surgery patients using daily chest radiograph for 3 days. There was no change in position in those patients who underwent surgery in the supine position, but there was some retraction in those who underwent surgery in the lateral position: day 1, 0.69 (1.1) cm; day 2, 0.35 (0.67) cm; p < 0.05. Nine (39%) catheters were found to be unintentionally directed cephalad. Chest radiograph appears to be a simple method of monitoring epidural catheter position. The factors responsible for catheter migration have yet to be adequately determined. ACKNOWLEDGMENT
Papers reviewed in this issue were selected from those published in the following journals: American Heart Journal, American Journal of
Cardiology, Anaesthesia, Annals of Thoracic Surgery, Journal of American College of Cardiology, Journal of Vascular Surgery, New England Journal of Medicine, and Vascular Surgery. Contributions to this section were made by Dr Paul Myles, Department of Anaesthesiology and Pain Management, Alfred Hospital, Prahran, Victoria, Australia, and Dr David Moskowitz, Department of Anesthesiology, Mount Sinai Hospital, New York, NY.