Comparative Characterization of Various Types of Postoperative Analgesia in Patients with Lung Cancer

Abstract

Objective: to comparatively study the efficiency of postoperative analgesia in patients with lung cancers, by using patient-controlled intravenous analgesia (PCIA), continuous epidural analgesia (EA) + PCIA, and intrapleural analgesia (IPA) + PCIA. Subjects and methods. Forty-six patients who had undergone thoracotomy and lung resection were examined. According to the mode of analgesia, the patients were divided into 3 groups: A (n=16) PCIA with 0.1% morphine, by applying programmed syringe pumps; B (n=14) continuous epidural infusion of 0.2% ropivacaine solution + PCIA with morphine; C (n=16) intrapleural bolus infusion of 0.5% ropivacaine + PCIA. The degree of sedation and the incidence and degree of side paranarcotic effects were estimated. Results. The use of mono-PCIA in patients who have undergone high-traumatic surgery is characterized by its low efficiency and a high rate of adverse reactions as compared with the other methods. Group A showed excess sedation in 12.5%, skin itching in 18.7%, urine retention in 6.3%, and nausea/vomiting in 18.8%. There was only one case of vomiting and one case of skin itching in both Group B and Group C. This was due to the significantly lower amount of morphine used during continuous EA and IPA. The daily amount of morphine averaged 0.63, 0.19, and 0.2 mg/kg/day in Groups A, B, and C, respectively (p<0.01). Conclusion. The postoperative employment of continuous EA and IPA increased patient mobility and improved external respiratory and cardiohemodynamic parameters, causing a reduction in the number of pyoseptic complications and convalescence time. In patients who have undergone lung resection, IPA fully meets the patient needs for pain relief and may be recommended for postoperative analgesia along with EA. Key words: thoracotomy, patient-controlled intravenous analgesia, continuous epidural analgesia, intrapleural analgesia.