PMID- 30233861
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220409
IS  - 2072-1439 (Print)
IS  - 2077-6624 (Electronic)
IS  - 2072-1439 (Linking)
VI  - 10
IP  - 8
DP  - 2018 Aug
TI  - Comparison of different methods of postoperative analgesia after thoracotomy-a 
      randomized controlled trial.
PG  - 4874-4882
LID - 10.21037/jtd.2018.07.88 [doi]
AB  - BACKGROUND: Continuous thoracic epidural analgesia (TEA) is a preferred method of 
      postoperative analgesia in thoracic surgery. Intravenous patient-controlled 
      analgesia (IVPCA) may be an effective alternative. One of the most commonly used 
      opioids in PCA is morphine. It has high antinociceptive efficacy but is 
      associated with many adverse events. Oxycodone can be an alternative. A small 
      number of scientific reports comparing morphine and oxycodone in PCA for the 
      treatment of acute postoperative pain after thoracotomy was the reason to conduct 
      this study. METHODS: Prospective, randomised, observational study. In total of 99 
      patients scheduled for elective thoracotomy were randomized into three study 
      groups. TEA group received continuous TEA as a method of postoperative pain 
      management, morphine (MF) group received morphine IVPCA, and morphine (OXY) group 
      oxycodone IVPCA. For 48 hours' hemodynamic parameters, level of pain, sedation 
      and the need for rescue analgesia were monitored. After 48 hours' patients were 
      asked about their satisfaction with pain treatment using Likert scale and 
      assessment of opioid related adverse events via overall benefit of analgesia 
      score (OBAS). RESULTS: The level of pain in visual analogic score (VAS) and 
      Prince Henry Hospital Pain Score (PHHPS) scales was significantly lower in TEA 
      group with no significant difference between groups MF and OXY. Using morphine in 
      PCA was associated with a significantly higher likelihood of need of rescue 
      analgesia. The level of sedation in Ramsay scale was significantly higher in MF 
      compared to OXY and TEA group. There were no significant differences between 
      groups in OBAS scale. TEA group was characterized by the highest degree of 
      patient satisfaction. CONCLUSIONS: TEA provided superior anaesthesia compared to 
      PCA in our study group. Use of PCA oxycodone in postoperative pain management 
      after open thoracotomy provides similar nociception control compared to morphine 
      but is associated with less sedation and patients using oxycodone IVPCA require 
      smaller doses of rescue analgesia compared to systemic morphine IVPCA.
FAU - Bialka, Szymon
AU  - Bialka S
AD  - Department of Anaesthesiology and Critical Care, School of Medicine with Division 
      of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland.
FAU - Copik, Maja
AU  - Copik M
AD  - Department of Anaesthesiology and Critical Care, School of Medicine with Division 
      of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland.
FAU - Daszkiewicz, Andrzej
AU  - Daszkiewicz A
AD  - Department of Anaesthesiology and Critical Care, School of Medicine with Division 
      of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland.
FAU - Rivas, Eva
AU  - Rivas E
AD  - Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
FAU - Ruetzler, Kurt
AU  - Ruetzler K
AD  - Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
FAU - Szarpak, Lukasz
AU  - Szarpak L
AD  - Faculty of Medicine, Lazarski University, Warsaw, Poland.
AD  - Department of Emergency Medicine, Warsaw Medical University, Warsaw, Poland.
FAU - Misiolek, Hanna
AU  - Misiolek H
AD  - Department of Anaesthesiology and Critical Care, School of Medicine with Division 
      of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland.
LA  - eng
PT  - Journal Article
PL  - China
TA  - J Thorac Dis
JT  - Journal of thoracic disease
JID - 101533916
PMC - PMC6129891
OTO - NOTNLM
OT  - Postoperative analgesia
OT  - morphine
OT  - oxycodone
OT  - patient-controlled analgesia (PCA)
OT  - thoracotomy
COIS- Conflicts of Interest: The authors have no conflicts of interest to declare.
EDAT- 2018/09/21 06:00
MHDA- 2018/09/21 06:01
PMCR- 2018/08/01
CRDT- 2018/09/21 06:00
PHST- 2018/09/21 06:00 [entrez]
PHST- 2018/09/21 06:00 [pubmed]
PHST- 2018/09/21 06:01 [medline]
PHST- 2018/08/01 00:00 [pmc-release]
AID - jtd-10-08-4874 [pii]
AID - 10.21037/jtd.2018.07.88 [doi]
PST - ppublish
SO  - J Thorac Dis. 2018 Aug;10(8):4874-4882. doi: 10.21037/jtd.2018.07.88.