Epidural methadone for acute post-thoracotomy pain: An alternative to a ropivacaine plus fentanyl-based patient-controlled epidural regimen

Perez, Jordi; Jiménez, Maria-Jose; Fita, Gillermina; Rovira, Irene; Catalan, Miquel; Gomar, Carmen

doi:10.1016/j.acpain.2007.08.024

« Previous Next »Acute Pain
Volume 9, Issue 4 , Pages 193-199, December 2007

Epidural methadone for acute post-thoracotomy pain: An alternative to a ropivacaine plus fentanyl-based patient-controlled epidural regimen

Jordi Perez
- Department of Anaesthesia, Hospital Clinic, University of Barcelona, Villarroel 170, Barcelona 08036, Spain
- Corresponding author. Tel.: +34 93 227 5558; fax: +34 93 451 75 53.
Maria-Jose Jiménez
- Department of Anaesthesia, Hospital Clinic, University of Barcelona, Villarroel 170, Barcelona 08036, Spain
Gillermina Fita
- Department of Anaesthesia, Hospital Clinic, University of Barcelona, Villarroel 170, Barcelona 08036, Spain
Irene Rovira
- Department of Anaesthesia, Hospital Clinic, University of Barcelona, Villarroel 170, Barcelona 08036, Spain
Miquel Catalan
- Department of Thoracic Surgery, Hospital Clinic, University of Barcelona, Spain
Carmen Gomar
- Department of Anaesthesia, Hospital Clinic, University of Barcelona, Villarroel 170, Barcelona 08036, Spain

Received 6 May 2007; received in revised form 24 July 2007; accepted 16 August 2007.

Summary

Accurate management of acute post-thoracotomy pain can be obtained with epidural local anaesthetics with or without opioids. The routine in our centre for many years has been boluses of epidural methadone with satisfactory results and a lack of serious complication.

Objectives To compare the analgesic effectiveness of two epidural regimens for acute post-thoracotomy pain management.

Methods We enrolled 49 patients undergoing lung resection by thoracotomy in a prospective, non-blinded open study. Study groups: 25 patients received a patient controlled epidural (PCEA) regimen of 0.16% ropivacaine plus 3.5μgml⁻¹ fentanyl, and the other 24 patients receiving 4–6mg of epidural boluses of 0.1% methadone every 8h.

Results Both regimens provided similar pain relief during the first two postoperative days, however, patients receiving methadone needed less rescue analgesia and presented fewer numbers of hypotensive events compared to PCEA patients.

Conclusions Epidural boluses of methadone are as a safe and adequate analgesic regiment as a PCEA with ropivacaine plus fentanyl for post-thoracotomy pain management. Additionally, the cost of our current technique is much lower than the ropivacaine infusion.

Keywords: Epidural, Methadone, Postoperative analgesia, Ropivacaine, Thoracotomy