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thoracotomy ; bupivacaine ; epidural analgesia ; Ravitch procedure ; morphine
Abstract:
The objective of this study was to evaluate the effectiveness and safety ofthoracic epidural analgesia with repeated doses of bupivacaine and morphinethrough its comparison with standard continuous intravenous infusion of morphine.A prospective observational study included 149 children, aged between 7 and 18years, after thoracic surgery. Patients were monitored during intraoperative periodand 24 hours after extubation. The following variables were measured and recorded:pain intensity, hemodynamic parameters, sedation level, the incidence and type ofadverse effects, and patient’s subjective evaluation of analgesic quality. The studyshowed that epidural analgesia is more effective when compared with continuousintravenous infusion of morphine. The effectiveness of pain management correlatedwith the type of analgesic procedures, however it wasn’t related to patient’s age,gender, and the type of thoracic access. Postoperative analgesia based on the dosesof drugs, which are calculated after pain intensity and sedation level are measuredhas no significant influence on hemodynamic profile, patient’s consciousness andthe incidence of adverse effects. Epidural analgesia in the thoracic level is a safemethod of pain control under the condition of continuous monitoring of patient’sstatus, which allows early detection of potential complications and application ofadequate treatment. Pain int ; ensity measurement with a numeric rating scaleaccording to the Prince Henry Hospital Pain score allows precise assessment of painboth at rest and in dynamic conditions. As a result analgesic drugs can be selected inrelation to patient’s individual needs.