Postoperative Analgesia: Comparing Interpleural Block and Epidural Anesthesia

Abstract

Model: Prospective, randomized, double-blind clinical trialPurpose: The main goal of this research was to compare the efficacy of the interpleural block and theepidural anesthesia, associated to general anesthesia, in the postoperative pain control of upper abdominal surgery.Methods: Eighty patients, allocated in eight groups (G) (n=10), of both genders, with ages varying from 18to 50 years, weight between 50 and 100kg, physical status ASA P1 and P2, submitted to subcostalcholecystectomy under interpleural block (I) or epidural anesthesia (P) associated to general anesthesiawere included in this study. They received levobupivacaine (L) 0,5% (100 mg) with adrenaline (5 µg.mL-1)or ropivacaine (R) 0,75% (150 mg), morphine (M) (3 mg) and clonidine (C) (3 µg.kg-1) or dextroketamine(K) (0,5 mg.kg-1), at the 7th intercostal space, in the mid axillary line, using a Tuohy 17G needle throughinterpleural route. The same medications were administered through epidural route, at the level of T12 - L1,using a Tuohy 17G needle. General anesthesia was induced with etomidate (0,2 mg.kg-1), alfentanil (30µg.kg-1) and rocuronium (0,6 mg.kg-1) and was maintained with oxygen and isoflurane (0,5 vol% at 3,0vol%).The postoperative analgesia was checked at six, twelve, eighteen and twenty-four hours after thesurgical procedure according to the Pain Verbal Analogic Scale. Results: Until six hours after surgery, 14 patients undergoing interpleural block and 7 undergoing epidural anesthesia felt pain. From six to twelve hours, 32 patients undergoing interpleural block and 14undergoing epidural anesthesia presented pain. Between twelve and eighteen hours, 34 patients undergoing interpleural block and 21 undergoing epidural anesthesia felt pain. From eighteen to twenty-fourhours, 36 patients undergoing interpleural block and 25 undergoing epidural anesthesia presentedpain. A statistically significant difference was observed comparing the techniques at the period between6 -12h, 12-18h and 18-24h. Eight patients undergoing interpleural block and three undergoing epiduralanesthesia required opioid.Conclusions: It was observed a decrease in the intensity of the pain and in the use of postoperative painmedication, in both used techniques.