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High Thoracic Epidural with Sufentanil for Post-Thoracotomy Pain

High thoracic epidural sufentanil was evaluated for postoperative pain relief in 20 patients who underwent thoracotomy for lung resection or correction of chest wall deformities. Measurements of latency and duration using the inverse visual analog scale (IVAS) indicated a rapid onset with a score >4.3 in 5 minutes and 7.3 at 15 minutes and a mean maximum score of 9.3. Mean duration of analgesia was 363 ± 25 minutes. Effects on respiration included a mean percentage decrease in respiratory rate of 20%, 30 minutes after the first and second injections and a corresponding increase in the PaCO2 of 8.8% and 26.3%, respectively, at the same time. Maximum plasma sufentanil levels at 5 minutes were 0.0454 ± 0.0109 ng/ml−1 and 0.1560 ± 0.0218 ng/ml−1 after the first and second injections, respectively. Cardiovascular measurements without exception remained within normal limits throughout the study period. Other side effects of epidural narcotics including pruritus, nausea, and vomiting were not seen. Urinary retention requiring catheterization occurred in seven patients (33%). This study indicated that despite the intensity of post-thoracotomy pain and in contrast with other epidural opioids, sufentanil was potent enough in the dose administered to allow unrestricted passive and voluntary chest physiotherapy to be undertaken.