Interpleural versus epidural analgesia with ropivacaine for postthoracotomy pain and respiratory function

Abstract

Study objective: To evaluate the impact of interpleural analgesia (IP) on postthoracotomy pain and respiratory function as an alternative to thoracic epidural analgesia (TEA).

Design: Prospective, randomized study.

Setting: Tertiary-care military hospital.

Patients: Sixty young patients scheduled for elective thoracic surgery (correction of aorta coarctation and patent ductus arteriosus).

Interventions: Patients were randomized into two groups to receive either IP or TEA for postthoracotomy pain management.

Measurements: Patients in the IP group (n = 30) had a catheter inserted between the parietal and visceral pleura by a surgeon, and 0.2% ropivacaine was given through this catheter. In the TEA group, ropivacaine was administered through a thoracic epidural catheter. The impact of both methods on pain control, respiratory function, and pulmonary complications was analyzed and compared.

Main results: The frequency of atelectasis and pleural effusion was also significantly high in the IP group (P < 0.01). Respiratory function and postoperative pain scores were better in the TEA group (P < 0.01). Arterial blood gas analysis on the fifth postoperative day was significantly better in the TEA group.

Conclusion: Thoracic epidural analgesia has more beneficial effects on respiratory function and postoperative pain after thoracotomy than does IP.