மயக்க மருந்து & மருத்துவ ஆராய்ச்சி
திறந்த அணுகல்

சுருக்கம்

Thoracic Epidural Analgesia vs. IV Analgesia after Lung Transplant: A Comparison of Post-operative Pain Management and Ventilatory Outcomes

Garrett A Enten, Suvikram Puri, Kapil Patel, Zachary Stachura, Erin Schwaiger, Pratik Patel and Enrico M Camporesi

Background: Few reports have evaluated postoperative continuous thoracic epidural analgesia on patients who received lung transplant. This analgesic modality may facilitate extubation, early ambulation, and achieve adequate pain control with minimization of opioid use. An opioid sparing technique could minimize the side effects of opioids such as ileus, constipation, and somnolence.

Methods: A retrospective chart review following local IRB approval was performed. A total of 97 patient’s charts were collected, from April 2015 to March 2017. Forty-eight patients received T6-T7 epidural, and forty-nine patients received standard intravenous analgesia. Outcome measures collected included length of intensive care unit stay, total duration of hospitalization, need for reintubation or noninvasive intermittent positive pressure ventilation (NIPPV), need for IV lidocaine gtt, and total narcotics consumption during hospitalization in milligrams of morphine equivalents (MME).

Results: Both groups were comparable in age, BMI, and race/gender distribution. Additionally, patient pain requirements were comparable between groups. However, a significantly smaller proportion of thoracic epidural patients required NIPPV post-operatively, (20.4%, 53.2%: p=0.0015). Further, the number of patients requiring reintubation was almost halved, (12.5%, 21.3%: NS). Patients receiving thoracic epidural also experienced shorter ICU times (p=0.0335) and on average, an overall reduced length of stay by six days.

Conclusions: For patients undergoing lung transplant, epidural analgesia is a viable alternative to intravenous pain control. Further, it significantly reduced respiratory depression and length of stay in the ICU. More refined comparisons can be made by conducting a precise prospective study with a more structured protocol in place.