Sagiroglu, G., Meydan, B., Copuroglu, E., Baysal, A., Yoruk, Y., Altemur Karamustafaoglu, Y., & Huseyin, S. (2014). A comparison of thoracic or lumbar patient-controlled epidural analgesia methods after thoracic surgery. World Journal of Surgical Oncology, 12, 96-7819-12-96. 

To compare the hemodynamic and analgesic effects of patient-controlled thoracic or lumbar epidural analgesia methods in a prospective, randomized study design after thoracotomy operations

One hundred and twenty patients were prospectively randomized to receive either thoracic epidural analgesia (TEA group) or lumbar epidural analgesia (LEA group) for a 24-hour postoperative period. Epidural catheters were administered in both groups. Hemodynamic measurements, Visual Analog Scale scores at rest (VAS-R) and after coughing (VAS-C), analgesic consumption, and side effects were compared at 0, 2, 4, 8, 16, and 24 hours postoperatively.

• N = 120
• AGE RANGE = 48–86 years (TEA group: 55.37 years [SD = 13.3 years], LEA group: 52.73 years [SD = 13.33 years])
• MALES: 87.7% (TEA); 85.7% (LEA), FEMALES: 12.3% (TEA); 14.3% (LEA) 
• KEY DISEASE CHARACTERISTICS: Diagnosis of lung cancer
• OTHER KEY SAMPLE CHARACTERISTICS: Posterolateral thoracotomy American Society of Anesthesiologists (ASA) physical status I, II, or III. Exclusion criteria included ASA physical status > III, known drug allergies, prior lumbar spine surgery, pregnancy, abnormal coagulation tests, a history of comorbidities such as hepatic or renal disease, or a neurologic impairment causing the inability to understand consent or pain measurement.

• SITE: Single site    
• SETTING TYPE: Inpatient    
• LOCATION: Sureyyapasa Chest Disease and Thoracic Surgery Hospital

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Elder care and palliative care 

• Prospective, randomized, double-blinded, controlled study

All measurements were compared at 0, 2, 4, 8, 16, and 24 hours postoperatively.

• Hemodynamic measurements
• Visual Analog Scale at Rest (VAS-R) and after Coughing (VAS-C)
• Analgesic consumption
• Side effects

The VAS-R and VAS-C values were lower in the TEA group when compared to the LEA group at 2, 4, 8, and 16 hours after surgery. The total 24-hour consumption of analgesics was lower in the TEA group. The incidence of hypotension, bradycardia, atelectasis, and the need for intensive care unit treatment was lower in the TEA group. There was no difference in incidence of cardiac or pulmonary complications or the occurrence of epidural morphine-related side effects. Both techniques provided efficient analgesia.

TEA had beneficial hemostatic effects and satisfactory pain relief after thoracotomies in comparison to LEA.

• Findings not generalizable

Epidural analgesia is used after a thoracotomy to diminish the incidence of possible pulmonary and cardiac complications. TEA has beneficial hemodynamic effects in comparison to LEA after thoracotomies along with a more satisfactory pain relief profile during the 24-hour postoperative period.