Comparison of Intravenous Morphine, Epidural Morphine With/ Without Bupivacaine or Ropivacaine in Postthoracotomy Pain Management With Patient Controlled Analgesia Technique

Background and objectivesThe aim of this randomized, double-blinded, prospective study was to determine the effectiveness and side effects of intravenous or epidural use of morphine, bupivacaine or ropivacaine on post-thoracotomy pain management.MethodsSixty patients undergoing elective thoracotomy procedure were randomly allocated into 4 groups by the sealed envelope technique. Group IVM, EM, EMB and EMR received patient controlled intravenous morphine, and epidural morphine, morphine-bupivacaine and morphineropivacaine, respectively. Perioperative heart rate, blood pressure and oxygen saturation and postoperative pain at rest and during cough, side effects and rescue analgesic requirements were recorded at the 30th and 60th minutes and the 2nd, 4th, 6th, 12th, 24th, 36th, 48th, and 72nd hour.ResultsDiclofenac sodium requirement during the study was lower inGroup EM. Area under VAS-time curve was lower in Group EM compared to Group IVM, but similar to Group EMB and EMR. Pain scores at rest were higher at the 12, 24, 36, and 48th hour in Group IVM compared to Group EM. Pain scores at rest were higher at the 30th and 60th minutes in Group EM and Group IVM compared to Group EMB. Pain scores during cough at the 30th minute were higher in Group EM compared to Group EMB. There was no difference between Group IVM and Group EMR.ConclusionsMorphine used at the epidural route was found more effective than the intravenous route. While Group EM was more effective in the late period of postoperative, Group EMB was more effective in the early period. We concluded that epidural morphine was the most effective and preferred one.

ResumoJustificativa e objetivosO objetivo deste estudo randomizado, duplo-cego e prospectivo foi determinar a eficacia e os efeitos colaterais da administracao por via intravenosa ou epidural de morfina, bupivacaina ou ropivacaina no tratamento da dor pos-toracotomia.MetodosSessenta pacientes submetidos a procedimentos de toracotomia eletiva foram randomicamente alocados em quatro grupos com o uso da tecnica de envelopes lacrados. Os grupos MIV, ME, MEB e MER receberam morfina controlada pelo paciente por via intravenosa, e morfina, morfina-bupivacaina e morfina- ropivacaina epidural, respectivamente. Frequencia cardiaca, pressao arterial e saturacao de oxigenio perioperatorias e dor pos-operatoria em repouso e durante a tosse, efeitos colaterais e necessidade de analgesicos de resgate foram registrados aos 30 e 60 minutos e em duas, quatro, seis, 12, 24, 36, 48 e 72 horas.ResultadosA necessidade de sodio diclofenaco durante o estudo foi menor no grupo ME. A area sob a curva de tempo na VAS foi menor no grupo ME em comparacao com o Grupo MIV, mas similar aos Grupos MEB e MER. Os escores de dor em repouso foram maiores nos tempos 12, 24, 36 e 48 horas no Grupo MIV em comparacao com o Grupo ME. Os escores de dor em repouso foram maiores aos 30 e 60 minutos nos Grupos ME e MIV em comparacao com o Grupo MEB. Os escores de dor durante a tosse aos 30 minutos foram maiores no grupo ME em comparacao com o Grupo MEB. Nao houve diferenca entre os Grupos MIV e MER.ConclusoesMorfina administrada por via epidural foi mais eficaz do que por via intravenosa. A eficacia foi maior no grupo EM no periodo pos-operatorio tardio e no Grupo MEB no periodo pos-operatorio inicial. Concluimos que morfina administrada por via epidural foi a mais eficaz e preferida.