Résumé
Objectif
Comparer ľeffet de la rachianalgésie à la morphine (M) et au sufentanil (S) à la péridurale thoracique sur ľanalgésie et la fonction respiratoire après chirurgie thoracique.
Matériel et méthodes
Quarante-cinq patients de 58,4 ± 13 ans ďâge moyen subissant une thoracotomie postéro-latérale ont été divisés en deux groupes. Les patients du Groupe I (n = 27) ont reçu une rachianalgésie lombaire (5 μg de S et 0,5 mg de M) une heure avant ľinduction. Groupe II (n = 28) a reçu après ľinduction, 10 à 20 mL ďune solution de bupivacaine (B) 0.25 % et fentanyl (F) 2 μg·mL-1 à travers un cathéter péridural installé entre T5 et T8 avant ľinduction. Une perfusion continue de cette solution a été administrée en période peropératoire. Après chirurgie et pendant 48 h, une perfusion de B 0.1 % et F 2 μg·mL-1 a été administrée avec des bolus toutes les 15 min si nécessaire. Les variables étudiées sont: la fréquence cardiaque (FC), la pression artérielle moyenne (PAM), la saturation périphérique en O2 (SpO2), la fréquence respiratoire (FR), la pression artérielle en O2 (PaCO2), le volume expiratoire maximal à la première seconde, la capacité vitale fonctionnelle, le débit expiratoire maximal et ľéchelle visuelle analogique (EVA) de la douleur au repos et au mouvement et ceci à différents temps allant de la veille de la chirurgie à T48 = 48 h après chirurgie.
Résultats
ĽEVA au repos et au mouvement, la FC, la PAM, la SpO2, la PaCO2, la FR et les variations des tests pulmonaires sont comparables dans les deux groupes.
Conclusion
La rachianalgésie à la M et au S a des effets comparables à la péridurale thoracique à la B et au F sur ľanalgésie et la fonction respiratoire après chirurgie thoracique.
Abstract
Purpose
To compare in a prospective randomized trial the effects of thoracic epidural infusions of fentanyl (F) and bupivacaine (B) to intrathecal morphine (M) and sufentanil (S) on analgesia and respiratory function following thoracotomy.
Patients and methods
55 patients undergoing an elective posterolateral thoracotomy were randomly assigned to one of two groups: Group I (n = 27): received intrathecal S (5 μg) and M (0.5 mg) one hour before surgery. Group II (n = 28) received, after induction of anesthesia, an initial dose of 10 to 20 mL of a solution of B 0.25% and F 2 μg·mL-1 via an epidural thoracic catheter previously inserted between T5 and T8. The same solution was infused during surgery. After surgery, patients received a continuous infusion of B 0.1% and F 2 μg·mL-1 with a bolus every 15 min if needed. Heart rate (HR), mean arterial pressure (MAP), SpO2, PaCO2, respiratory rate (RR), forced expiratory volume in one second, peak expiratory flow rate and forced vital capacity were recorded at different times from the day before surgery till T48 = 48 hr after surgery. Subjective pain was assessed using a 10 cm visual analogue scale (VAS) scoring at rest and during cough.
Results
No significant difference was noted between both groups concerning VAS, HR, MAP, SpO2, PaCO2 and RR. Variations of the respiratory function tests were identical in both groups.
Conclusion
This study shows that intrathecal M and S offer analgesia comparable to thoracic epidural infusion of B and F.
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Madi-Jebara, S., Adaimé, C., Yazigi, A. et al. L’analgésie péridurale thoracique et rachidienne ont des effets comparables sur la douleur et la fonction respiratoire après chirurgie thoracique. Can J Anesth 52, 710–716 (2005). https://doi.org/10.1007/BF03016558
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DOI: https://doi.org/10.1007/BF03016558