2. Department Of Thoracic Surgery, Ibn Rochd Universitary Hospital, Casablanca, Morocco.
Objectives: Thoracotomy is the cause of severe postoperative pain and prolonged (3-5 days) purveyors of multiple complications mainly respiratory ones. The thoracic epidural analgesia (TEA) is currently considered as the "gold standard" analgesic. This technique requires prolonged hospitalization in intensive care unit (ICU) to administer continuous mixing (local anesthetic+opioid) using an electric syringe pump (ESP).
Purpose: If elastomeric pumps (EP) have already demonstrated their effectiveness in orthopedics and visceral surgery, their place in TEA remains unclear. We report our experience with their use for the maintenance of TEA in thoracic surgery.
Materials and methods: All consecutive patients operated January to June 2012 for lung surgery (lobectomy, pneumonectomy or atypical resection) by thoracotomy were studied prospectively in the early postoperative period (first 5 days) in ICU. The patients were operated under general anesthesia (GA) and TEA is systematically proposed, the epidural catheter is in place at T4-T5 before induction of GA. Postoperatively, patients were randomized into 2 groups: group A received a mixture containing a local anesthetic (LA), in this case 0.125% bupivacaine and morphine (fentanyl: 1 mg/ml of AL). This mixture was continuously administered to the patient using an ESP while Group B received the same mixture from an EP. Several parameters were analyzed during the 96 hours post-operative sensory level, Bromage score, complications, analgesic consumption, visual analogue scale (VAS) at rest, cough and mobilization as well as overall patient satisfaction.
Results: After thoracotomy, continuous administration of a mixture containing 0.125% bupivacaine associated to fentanyl through an epidural catheter with a PE provides effective postoperative analgesia with few side effects.
Conclusion: To reduce the cost of hospitalization in the ICU and reduce consumption of analgesics after surgery, the PE could be used in surgical services subject to rigorous monitoring, and continues with a highly trained nursing staff.
Keywords: Thoracic-surgery, epidural-analgesia, elastomeric-diffuser, electric-pump