The Effectiveness Of Comprehensive Epidural Analgesia And Single Epidural Block Plus Intravenous PCA On Acute And Chronic Pain After Thoracic Surgery

BackgroundChronic post-surgical pain(CPSP),including chronic posttraumtic pain,has drawn our attentions because of their high incidence in recent years.Thoracic surgery was one of the types that were subject to develop into CPSP.A handful of factors,such as the age,gender,analgesics et,can affect the development of CPSP.The thoracic epidural analgesia(TEA)can decrease the acute pain after thoracic surgeries,however there was still not reach an consensus for the effectiveness of it on the chronic pain.ObjectiveThe present study was designed to observe the effectiveness of comprehensive epidural analgesia and single epidural block plus intravenous PCA on acute and chronic pain after thoracic surgeries.Materials and methodsAll patients who were included in the study were randomly allocated comprehensive epidural analgesia group(CEDA group)and Patient controlled intravenous analgesia group(PCIA group)depending on the random number table.The patients were premedicated on the ward with 20mg Scopolamine.Before induction,every patient experienced a thoracic epidural catheter placement at the T4-T5 or T4-T6.After the experiment dose was given,the intraepidural infusion of ropivacaine 0.125%and sufentany 0.5?g/ml were administrated.When the block plane arrived at the level T4-T8,all the patients underwent a general anesthesia.When closing the pleura,thoracic epidural analgesia pump was connected in CDEA group.The epidural catheter was removed when closing the pleura on the PCIA group,and then the intravenous PCA pump was connected.The intensity at rest and movement were recorded at each time point.The patients were followed by telephone and asked whether they feel pain at the incision at 2nd,4th,6th months.The intensity and characteristic of the pain,the total amount of postoperative analgesics and the dosage of remedy analgesics were recorded.The incidence of adverse reactions were recorded,mainly including bradycardia(HR<50 beats/min),hypotension(systolic blood pressure<90mmHg),respiratory depression(RR<10 beats/min),nausea,vomiting,drowsiness,itching,etc.ResultsUltimately,fifty patients were involved in the analysis(37 males and 13 females,aged 18-65 years).Compared with PCIA group,in the CEDA group,the VAS at 3,6,12,24,48,72 h in rest and the VAS at 6,12,24 h were lower after surgery(all P<0.05).Compared with PCIA group,in the CEDA group,the incidence of pain free at 3,6,12,24,48,72 h in rest and the incidence of pain free at 6,12,24,48 h in movement were higher after surgery(all P<0.05).The consumption of remedy analgesics(tramadol)in CEDA group were lower during 72 h after surgery(P<0.05).The consumption of sufentanil in CEDA group were lower at 3,6,12,24,48,72 h after surgery(P<0.05).However,there were no statistical difference on the incidence of chronic pain,paresthesia,shoulder pain,nausea and vomiting at 2nd,4th,6th month after surgery between the two groups(all P>0.05).Pruritus,uroschesis,respiratory depression and other side-effects were not observed during the study in both groups.ConclusionsFor thoracic surgery patients,thoracic epidural analgesia don't decrease the incidence of chronic pain,paresthesia and shoulder pain at 2nd,4th,6th month postoperatively,but obviously alleviate the pain scores and severity of acute pain and decrease the consumption of sufentanil and remedy analgesics during 72 h after surgery.