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Effects of Epidural Bupivacaine After Thoracotomy
  1. Spencer Liu, M.D.*,
  2. Jose M. Angel, M.D.,
  3. Brian D. Owens, M.D.*,
  4. Randall L. Carpenter, M.D.* and
  5. Liette Isabel, M.D.
  1. *Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington
  2. Department of Anesthesiology, University of Colorado Health Science Center, Denver, Colorado;
  3. Department d'Anesthesie, Hopital Maisonneuve-Rosemont, Montreal, Canada
  1. Reprint requests: Dr. Liu, Department of Anesthesiology, Virginia Mason Medical Center, 1100 Ninth Avenue, P.O. Box 900, Seattle, WA 98111.


Background and Objectives. Combinations of bupivacaine and fentanyl are popular for postoperative epidural analgesia. However, there are little data from which to select a rational dose of bupivacaine. The study examined the effects of increasing amounts of epidural bupivacaine on postoperative analgesia, epidural fentanyl consumption, and side effects after thoracotomy.

Methods. Twenty-four patients were randomized in a double-blind manner to receive intra- and postoperative epidural infusions of either saline, 0.01% bupivacaine, 0.05% bupivacaine, or 0.1% bupivacaine at 10 mL/h. All patients received a standardized combined epidural (120 mg lidocaine and 1.5 μg/kg of fentanyl) and general anesthesia. Further postoperative analgesia was provided with fentanyl patient-controlled epidural analgesia (PCEA) only.

Results. There were no differences between groups in visual analog scale (VAS) pain scores at rest or cough, but 10 and 5 mg/h of bupivacaine provided better analgesia during physiotherapy (P < .05). The use of 10 and 5 mg/h of bupivacaine led to significant opioid sparing (50% decrease) when compared to saline and 1 mg/h bupivacaine (P < .03). There was a trend toward a greater incidence of orthostasis with the use of bupivacaine at 10 mg/h (P = .09). Incidences of opioid side effects were not different between groups.

Conclusions. The results demonstrate improved analgesia with physiotherapy and significant opioid sparing when 10 and 5 mg/h doses of bupivacaine are used. However, the incidence of orthostasis may be increased with the use of 10 mg/h. Thus, 5 mg/h of epidural bupivacaine (.05% at 10 mL/h) improved analgesia, decreased opioid requirements, and did not have detectable hemodynamic effects.

  • epidural anesthetic technique
  • epidural analgesia
  • bupivacaine
  • opioid
  • fentanyl
  • postoperative pain

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  • Supported by Abbott Laboratories, North Chicago, Illinois.

    Presented at the 1994 Annual Meeting of the American Society of Anesthesiologists, San Francisco, California, October 14-19.