J Korean Pain Soc.  2001 Jun;14(1):68-75.

The Effect of the Combined Analgesia of Epidural and Cryoanalgesia after Thoracotomy Surgery

• Shin JW
• Choi IC
• Ha SI
• Sim JY
• Lee C
• Park SI
• Yun CS

Abstract

BACKGROUND: Thoracotomy is the operation that produces the most postoperative pain, necessitating the highest requirements for postoperative analgesics. The common methods of treating postthoracotomy pain are the use of thoracic epidural analgesia, intemittent or continuous intercostal nerve blocks, intravenous narcotics and cryoanalgesia. We designed to assess the analgesic effect of epidural analgesia, cryoanalgesia and the combined analgesia in thoracic surgery.
METHODS
A prospective study was carried out in 59 patients undergoing elective thoracotomy for parenchymal disease. Patients were randomized into three groups: C (cryoanalgesia), CE (cryoanalgesia and thoracic epidural analgesia), E (epidural analgesia). All patients had standard anesthesia with endotracheal intubation using a double lumen endotracheal tube, and one-lung ventilation. Subjective pain relief was assessed on a visual analog scale. Analgesic requirements, complications and the degree of satisfaction were evaluated during the 7 days following surgery.
RESULTS
Subjective pain relief was significantly better in Group CE and Group E in comparison with Group C (P < 0.05). Cryoanalgesia provided a better pain score on the 6th and 7th POD than the early postoperative periods. Analgesic requirements were higher in Group C than in the Group CE and Group E during the first POD. The incidence of side effects was similar in Group CE and Group E.
CONCLUSIONS
If we can reduce the concentration of fentanyl and local anesthetics in combined analgesia of epidural and cryoanalgesia, the disadvantages of each method would be overcome and would be a better method of postthoracotomy pain control.

Keyword

Cryoanalgesia; Pain; Postoperative; Thoracic epidural; Thoracotomy

MeSH Terms

Analgesia*
Analgesia, Epidural
Analgesics
Anesthesia
Anesthetics, Local
Fentanyl
Humans
Incidence
Intercostal Nerves
Intubation, Intratracheal
Narcotics
One-Lung Ventilation
Pain, Postoperative
Postoperative Period
Prospective Studies
Thoracic Surgery
Thoracotomy*
Visual Analog Scale
Analgesics
Anesthetics, Local
Fentanyl
Narcotics