Anesthesia & Clinical Research
Open Access

Abstract

Effect of Induced Epidural Anesthesia before Surgical Incision on Acute Pain and Postoperative Pulmonary Events: Results from a Population with Lung Resection by Thoracotomy

De Wolf Julien, Deblauwe Delphine, Labreuche Julien, Duhamel Alain, Desbordes Jacques, Wattier Jean-Michel and Porte Henri

Introduction: Our study evaluated the effect on postoperative pain and pulmonary complications of a lidocaine injection in thoracic epidural anesthesia before surgical incision in patients with suspected lung cancer resected by thoracotomy.

Patients and methods: Between November 2012 and November 2013, we prospectively recruited patients requiring thoracotomy for suspected non-small cell lung cancer (NSCLC). All patients had a posterior lateral or lateral thoracotomy, and all had preoperative epidurals. Thoracic epidural catheter was removed 4 or 5 days after surgery. We studied NRS score on days 1 and 6 after surgery. Significant pain was defined as NRS>3. We recorded all pulmonary complications such as pneumonia, atelectasis requiring bronchoscopy, bronchopleural fistula, reintubation and tracheostomy.

Results: 128 patients were included; 91 patients were male and 37 were female (ratio M/F: 2.46). The median (IQR) NRS score at D1 and D6 post-surgery were 0 (0–3) and 2 (0–3) respectively. The prevalence of pain was 12.5% (95% CI 7.3–19.5) at D1, and 21.9% (95% CI 15.1–30.1) at D6. Postoperative pulmonary events arose in 24.2% of cases (n=31), including pneumonia in14.8% of cases (n=19), and atelectasis in 11.7% (n=15). No relationship was found between acute pain and pulmonary complications. There were no significant differences between groups of patients with and without pain related to the extent of lung resection or surgical technique. The D1 NRS score was correlated with the NRS score at D6 (r=0.24, P=0.006).

Conclusion: With our peroperative anesthetic management, postoperative acute pain is very low. Nevertheless, good care did not lead to a decrease in pulmonary complications. We conclude that thoracic epidural anesthesia should be induced before incision, to decrease acute post-thoracotomy pain.