Analgesia after thoracotomy

Effects of epidural fentanyl concentration/infusion rate

C. A. Thomson, D. R. Becker, J. M. Messick, M. A. De Castro, P. C. Pairolero, V. F. Trastek, M. J. Murray, N. K. Schulte, K. P. Offord, J. A. Ferguson

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

After thoracotomy some patients have discomfort, primarily in the rostral portion of their incisions. In this prospective, randomized study in 66 patients after lateral thoracotomy we evaluated whether, for equal fentanyl dosage in micrograms per kilogram, epidural infusion (lumbar catheter) of fentanyl 5 μg/mL provided better segmental analgesia (including the rostral portion of the incision) than a 10-μg/mL concentration infused at a rate half that used in the 5-μg/mL group. Ketorolac was used as an analgesic adjunct for nonincisional pain. Postoperative epidural fentanyl infusion included a 1-μg/kg initial dose and an initial infusion rate of 1 μg · kg-1 · h-1 in both the 5-μg/mL and 10μg/mL groups. Patients were evaluated for comfort level and pain relief while resting, taking a deep breath, coughing, and ambulating at eight times over 3 days using two visual analog scales for overall comfort and a verbal rating score (VRS) for segmental analgesia. There were no significant differences in demographics, surgical procedure, intraoperative fentanyl dose, side effects, rates of epidural fentanyl infusion, or total epidural fentanyl doses at 12, 24, 36, 48, and 60 h postbolus. Analgesia was effective in both groups. Although overall comfort levels were lower (i.e., indicated greater comfort) in the 5- μg/mL group in 6 of 8 visual analog scores (VASs) for comfort level and 20 of 24 VRSs for comfort level scores, and mean VRSs for the rostral portion of the incision were lower (i.e., indicated greater comfort) in the 5-μg/mL group at 21 of 24 evaluation subsets (one statistically significant), statistical significance was achieved in only six evaluation subsets. There were no significant differences between the two groups in averages of comfort level scores for the upper, middle, and lower portions of the incisions. Ketorolac was not a confounding variable. Lumbar epidural infusions of fentanyl can provide effective analgesia after thoracotomy; using lower concentrations at higher infusion rates is beneficial for some patients.

Original languageEnglish (US)
Pages (from-to)973-981
Number of pages9
JournalAnesthesia and Analgesia
Volume81
Issue number5
DOIs
StatePublished - 1995

Fingerprint

Fentanyl
Thoracotomy
Analgesia
Ketorolac
Pain
Confounding Factors (Epidemiology)
Visual Analog Scale
Analgesics
Catheters
Demography
Prospective Studies

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Thomson, C. A., Becker, D. R., Messick, J. M., De Castro, M. A., Pairolero, P. C., Trastek, V. F., ... Ferguson, J. A. (1995). Analgesia after thoracotomy: Effects of epidural fentanyl concentration/infusion rate. Anesthesia and Analgesia, 81(5), 973-981. https://doi.org/10.1097/00000539-199511000-00014

Analgesia after thoracotomy : Effects of epidural fentanyl concentration/infusion rate. / Thomson, C. A.; Becker, D. R.; Messick, J. M.; De Castro, M. A.; Pairolero, P. C.; Trastek, V. F.; Murray, M. J.; Schulte, N. K.; Offord, K. P.; Ferguson, J. A.

In: Anesthesia and Analgesia, Vol. 81, No. 5, 1995, p. 973-981.

Research output: Contribution to journalArticle

Thomson, CA, Becker, DR, Messick, JM, De Castro, MA, Pairolero, PC, Trastek, VF, Murray, MJ, Schulte, NK, Offord, KP & Ferguson, JA 1995, 'Analgesia after thoracotomy: Effects of epidural fentanyl concentration/infusion rate', Anesthesia and Analgesia, vol. 81, no. 5, pp. 973-981. https://doi.org/10.1097/00000539-199511000-00014
Thomson CA, Becker DR, Messick JM, De Castro MA, Pairolero PC, Trastek VF et al. Analgesia after thoracotomy: Effects of epidural fentanyl concentration/infusion rate. Anesthesia and Analgesia. 1995;81(5):973-981. https://doi.org/10.1097/00000539-199511000-00014
Thomson, C. A. ; Becker, D. R. ; Messick, J. M. ; De Castro, M. A. ; Pairolero, P. C. ; Trastek, V. F. ; Murray, M. J. ; Schulte, N. K. ; Offord, K. P. ; Ferguson, J. A. / Analgesia after thoracotomy : Effects of epidural fentanyl concentration/infusion rate. In: Anesthesia and Analgesia. 1995 ; Vol. 81, No. 5. pp. 973-981.
@article{a937e3b6999a4cd8ad95b7b6871282e8,
title = "Analgesia after thoracotomy: Effects of epidural fentanyl concentration/infusion rate",
abstract = "After thoracotomy some patients have discomfort, primarily in the rostral portion of their incisions. In this prospective, randomized study in 66 patients after lateral thoracotomy we evaluated whether, for equal fentanyl dosage in micrograms per kilogram, epidural infusion (lumbar catheter) of fentanyl 5 μg/mL provided better segmental analgesia (including the rostral portion of the incision) than a 10-μg/mL concentration infused at a rate half that used in the 5-μg/mL group. Ketorolac was used as an analgesic adjunct for nonincisional pain. Postoperative epidural fentanyl infusion included a 1-μg/kg initial dose and an initial infusion rate of 1 μg · kg-1 · h-1 in both the 5-μg/mL and 10μg/mL groups. Patients were evaluated for comfort level and pain relief while resting, taking a deep breath, coughing, and ambulating at eight times over 3 days using two visual analog scales for overall comfort and a verbal rating score (VRS) for segmental analgesia. There were no significant differences in demographics, surgical procedure, intraoperative fentanyl dose, side effects, rates of epidural fentanyl infusion, or total epidural fentanyl doses at 12, 24, 36, 48, and 60 h postbolus. Analgesia was effective in both groups. Although overall comfort levels were lower (i.e., indicated greater comfort) in the 5- μg/mL group in 6 of 8 visual analog scores (VASs) for comfort level and 20 of 24 VRSs for comfort level scores, and mean VRSs for the rostral portion of the incision were lower (i.e., indicated greater comfort) in the 5-μg/mL group at 21 of 24 evaluation subsets (one statistically significant), statistical significance was achieved in only six evaluation subsets. There were no significant differences between the two groups in averages of comfort level scores for the upper, middle, and lower portions of the incisions. Ketorolac was not a confounding variable. Lumbar epidural infusions of fentanyl can provide effective analgesia after thoracotomy; using lower concentrations at higher infusion rates is beneficial for some patients.",
author = "Thomson, {C. A.} and Becker, {D. R.} and Messick, {J. M.} and {De Castro}, {M. A.} and Pairolero, {P. C.} and Trastek, {V. F.} and Murray, {M. J.} and Schulte, {N. K.} and Offord, {K. P.} and Ferguson, {J. A.}",
year = "1995",
doi = "10.1097/00000539-199511000-00014",
language = "English (US)",
volume = "81",
pages = "973--981",
journal = "Anesthesia and Analgesia",
issn = "0003-2999",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Analgesia after thoracotomy

T2 - Effects of epidural fentanyl concentration/infusion rate

AU - Thomson, C. A.

AU - Becker, D. R.

AU - Messick, J. M.

AU - De Castro, M. A.

AU - Pairolero, P. C.

AU - Trastek, V. F.

AU - Murray, M. J.

AU - Schulte, N. K.

AU - Offord, K. P.

AU - Ferguson, J. A.

PY - 1995

Y1 - 1995

N2 - After thoracotomy some patients have discomfort, primarily in the rostral portion of their incisions. In this prospective, randomized study in 66 patients after lateral thoracotomy we evaluated whether, for equal fentanyl dosage in micrograms per kilogram, epidural infusion (lumbar catheter) of fentanyl 5 μg/mL provided better segmental analgesia (including the rostral portion of the incision) than a 10-μg/mL concentration infused at a rate half that used in the 5-μg/mL group. Ketorolac was used as an analgesic adjunct for nonincisional pain. Postoperative epidural fentanyl infusion included a 1-μg/kg initial dose and an initial infusion rate of 1 μg · kg-1 · h-1 in both the 5-μg/mL and 10μg/mL groups. Patients were evaluated for comfort level and pain relief while resting, taking a deep breath, coughing, and ambulating at eight times over 3 days using two visual analog scales for overall comfort and a verbal rating score (VRS) for segmental analgesia. There were no significant differences in demographics, surgical procedure, intraoperative fentanyl dose, side effects, rates of epidural fentanyl infusion, or total epidural fentanyl doses at 12, 24, 36, 48, and 60 h postbolus. Analgesia was effective in both groups. Although overall comfort levels were lower (i.e., indicated greater comfort) in the 5- μg/mL group in 6 of 8 visual analog scores (VASs) for comfort level and 20 of 24 VRSs for comfort level scores, and mean VRSs for the rostral portion of the incision were lower (i.e., indicated greater comfort) in the 5-μg/mL group at 21 of 24 evaluation subsets (one statistically significant), statistical significance was achieved in only six evaluation subsets. There were no significant differences between the two groups in averages of comfort level scores for the upper, middle, and lower portions of the incisions. Ketorolac was not a confounding variable. Lumbar epidural infusions of fentanyl can provide effective analgesia after thoracotomy; using lower concentrations at higher infusion rates is beneficial for some patients.

AB - After thoracotomy some patients have discomfort, primarily in the rostral portion of their incisions. In this prospective, randomized study in 66 patients after lateral thoracotomy we evaluated whether, for equal fentanyl dosage in micrograms per kilogram, epidural infusion (lumbar catheter) of fentanyl 5 μg/mL provided better segmental analgesia (including the rostral portion of the incision) than a 10-μg/mL concentration infused at a rate half that used in the 5-μg/mL group. Ketorolac was used as an analgesic adjunct for nonincisional pain. Postoperative epidural fentanyl infusion included a 1-μg/kg initial dose and an initial infusion rate of 1 μg · kg-1 · h-1 in both the 5-μg/mL and 10μg/mL groups. Patients were evaluated for comfort level and pain relief while resting, taking a deep breath, coughing, and ambulating at eight times over 3 days using two visual analog scales for overall comfort and a verbal rating score (VRS) for segmental analgesia. There were no significant differences in demographics, surgical procedure, intraoperative fentanyl dose, side effects, rates of epidural fentanyl infusion, or total epidural fentanyl doses at 12, 24, 36, 48, and 60 h postbolus. Analgesia was effective in both groups. Although overall comfort levels were lower (i.e., indicated greater comfort) in the 5- μg/mL group in 6 of 8 visual analog scores (VASs) for comfort level and 20 of 24 VRSs for comfort level scores, and mean VRSs for the rostral portion of the incision were lower (i.e., indicated greater comfort) in the 5-μg/mL group at 21 of 24 evaluation subsets (one statistically significant), statistical significance was achieved in only six evaluation subsets. There were no significant differences between the two groups in averages of comfort level scores for the upper, middle, and lower portions of the incisions. Ketorolac was not a confounding variable. Lumbar epidural infusions of fentanyl can provide effective analgesia after thoracotomy; using lower concentrations at higher infusion rates is beneficial for some patients.

UR - http://www.scopus.com/inward/record.url?scp=0028839159&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028839159&partnerID=8YFLogxK

U2 - 10.1097/00000539-199511000-00014

DO - 10.1097/00000539-199511000-00014

M3 - Article

VL - 81

SP - 973

EP - 981

JO - Anesthesia and Analgesia

JF - Anesthesia and Analgesia

SN - 0003-2999

IS - 5

ER -