Mercadante, S., Villari, P., Casuccio, A., & Marrazzo, A. (2008). A randomized-controlled study of intrathecal versus epidural thoracic analgesia in patients undergoing abdominal cancer surgery. Journal of Clinical Monitoring and Computing, 22, 293–298. 

DOI Link

Study Purpose

To evaluate the effectiveness of intrathecal thoracic analgesia compared to continuous epidural analgesia for postoperative pain management

Intervention Characteristics/Basic Study Process

One group of patients received continuous epidural analgesia started prior to surgery, and the other group received an intrathecal catheter that was placed prior to surgery. Data for pain levels, vomiting, and drowsiness were obtained at discharge from the recovery room and at one, two, four, eight, 12, 24, and 48 hours. In both groups, the continuous infusion was of levobupivacaine, which was preceded by a morphine bolus preoperatively.

Sample Characteristics

  • N = 48  
  • MEAN AGE = 63.7 years
  • MALES: 56.4%, FEMALES: 43.6%
  • KEY DISEASE CHARACTERISTICS: Disease types were not reported, but most patients had colorectal surgery. All patients were undergoing elective abdominal surgery.

Setting

  • SITE: Single site  
  • SETTING TYPE: Inpatient  
  • LOCATION: Italy

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active antitumor treatment
  • APPLICATIONS: Palliative care

Study Design

Randomized, parallel-group trial

Measurement Instruments/Methods

  • Numeric Rating Scale (NRS) for pain
  • Side effects were scored on a three-point Likert scale.
  • Vital signs
  • Motor blockade (modified four-point Bromage scale)
  • Four-point sedation level scale

Results

There were no significant differences between groups in pain intensity or total morphine consumption. There also were no significant differences between groups in Bromage scores, sedation scores, or vital signs.

Conclusions

Continuous intrathecal analgesia provided similar analgesic effects as continuous epidural infusion in the first two postoperative days.

Limitations

  • Small sample (< 100)
  • Risk of bias (no blinding)
  • Subject withdrawals ≥ 10%  
  • Other limitations/explanation: A percentage of patients was not included in the final analysis because of protocol violations or missing data. No intention to treat analysis was done.

Nursing Implications

Intrathecal analgesic infusion provided results similar to those of continuous epidural analgesia in terms of postoperative pain relief and side effects of pain management. This approach provides an alternative mechanism for acute pain management.