NSAIDs With Morphine-PCA Compared to Epidural Analgesia in Thoracotomy Pain

Helsinki University Central Hospital (HUCH)

Status: Completed

Conditions: Postoperative Pain

Treatments: Device: patient controlled epidural analgesia; Drug: Diclofenac; Drug: parecoxib/ valdecoxib

Study type: Interventional

Funder types: Other

Identifiers

NCT01541137

74555

Details and patient eligibility

About

The investigators investigated whether a strictly controlled pain management with patients participating in a clinical study can attenuate persistence of post-thoracotomy pain. The investigators also wanted to find out whether NSAID + intravenous patient-controlled analgesia with morphine is an efficacious alternative to thoracic epidural analgesia.

Enrollment: 30 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients scheduled for elective thoracotomy for lung surgery

Exclusion criteria

• Contraindication to any of the study drugs or an epidural catheter,
• Significant liver, renal or cardiac disease
• Peptic ulcer
• Regular use of analgesics
• Re-thoracotomy, and the patient´s inability to understand the use of PCA/patient controlled thoracic epidural analgesia (PCEA).

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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30 participants in 3 patient groups

diclofenac + IV-PCA

Active Comparator group

Description:

oral diclofenac 75 mg, a 44-hour iv-infusion of diclofenac 150 mg/24h, intercostal nerve block with 20 ml of 0.5% bupivacaine, IV-PCA programmed with morphine boluses, from the 2nd postoperative morning the patients were given oral diclofenac 75 mg x 2, IV-PCA-morphine was discontinued after removal of pleural drains, and the patients were given oral oxycodone

Treatment:

Drug: Diclofenac

parecoxib/ valdecoxib + IV-PCA

Active Comparator group

Description:

oral valdecoxib 40 mg, a 44-hour iv-infusion parecoxib 80 mg/24h, intercostal nerve block with 20 ml of 0.5% bupivacaine, IV-PCA programmed with morphine, From the 2nd postoperative morning valdecoxib 40 mg x 2, IV-PCA-morphine was discontinued after removal of pleural drains, and the patients were given oral oxycodone

Treatment:

Drug: parecoxib/ valdecoxib

patient controlled epidural analgesia

Active Comparator group

Description:

At the induction of anesthesia the PCEA-patients were given IV paracetamol 1g and an epidural loading dose of 1 ml/10 kg of 0.15% bupivacaine with fentanyl 6 µg/ml. Thereafter a continuous infusion was started at 1 ml/10 kg/h. In the PACU PCEA-patients could take incremental doses, IV paracetamol 1g x 4 for the first 24 hours and thereafter 1g x 3 orally, PCEA was discontinued and paracetamol was replaced with ibuprofen 600 mg x 3 and oral oxycodone

Treatment:

Device: patient controlled epidural analgesia