Patient-Controlled Epidural Analgesia After Thoracotomy: A Comparison of Meperidine With and Without Bupivacaine

• Published in: Anesthesia and analgesia Vol. 83; no. 1; pp. 81 - 86
• Main Authors: Etches, Richard C., Gammer, Terri-Lynn, Cornish, Rebecca
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01.07.1996; Lippincott
• Subjects: Adult; Aged; Analgesia, Epidural; Analgesia, Patient-Controlled; Analgesics; Analgesics, Opioid - therapeutic use; Anesthetics, Local - administration & dosage; Biological and medical sciences; Bupivacaine - administration & dosage; Double-Blind Method; Female; Humans; Male; Medical sciences; Meperidine - administration & dosage; Meperidine - therapeutic use; Middle Aged; Neuropharmacology; Pain, Postoperative - drug therapy; Pharmacology. Drug treatments; Prospective Studies; Thoracotomy; Human; Postoperative; Drug combination; Opiates; Self administration; Narcotic analgesic; Thoracotomy; Local anesthetic; Analgesia; Chemotherapy; Pain; Treatment; Surgery; Extradural administration; Anilide
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1097/00000539-199607000-00014

The purpose of this study was to compare meperidine to meperidine with bupivacaine when used for patient-controlled epidural analgesia (PCEA) after thoracotomy. For 3 days after thoracotomy patients received thoracic PCEA with meperidine 0.1% plain or with added bupivacaine 0.1% or 0.01%. No background infusion was used. All patients received indomethacin postoperatively for the duration of the study. Patients were assessed with respect to meperidine consumption, analgesia, and side effects. Sixty-six patients participated. Patients in all three groups obtained effective analgesia with median meperidine consumption of 5-6 mg/h. There were no significant differences between groups in meperidine consumption or pain scores at rest or with coughing. The addition of bupivacaine 0.1% reduced the incidence of pruritus (P = 0.036), but 5 of 23 patients in this group were withdrawn from the study because of significant hypotension, oliguria, and/or motor or sensory block (P = 0.006). We conclude that the addition of bupivacaine 0.1% or 0.01% to thoracic PCEA meperidine 0.1% does not affect meperidine requirements or analgesia after thoracotomy. The addition of bupivacaine 0.1% may reduce pruritus, but is associated with signs of excessive sensory, motor, or autonomic blockade in a significant number of patients.(Anesth Analg 1996;83:81-6)