Effects of epidural morphine and levobupivacaine combination before incision and after incision and in the postoperative period on thoracotomy pain and stress response

Abstract

Background/aim: This study aims to investigate the effects of thoracic epidural analgesia, before and after surgical incision and in thepostoperative period, on thoracotomy pain and stress response.Materials and methods: A total of 45 patients who were scheduled for posterolateral thoracotomy were included in this study. Acombination of epidural levobupivacaine and morphine was administered as a bolus before incision (Group 1; n=15), after incision(Group 2; n=15), or at the end of surgery (Group 3; n=15). Additionally, infusion was used in Group 1 and Group 2 during operation.Postoperative patient-controlled epidural analgesia infusion pumps were connected to all patients. Visual analog scale (VAS) scores andmorphine consumption were recorded during the postoperative 48 h. Glucose, insulin, cortisol, and C-reactive protein (CRP) levelswere compared before surgery and at 4, 24, and 48 h after the operation.Results: There were no differences in the morphine consumption and VAS scores for all measurements among the groups (P > 0.05).Both blood glucose levels at 4 h and CRP values at 48 h were higher in Group 2 than Group 1 (P 0.05).Conclusion: The application of thoracic epidural analgesia before and after surgical incision and in the postoperative period did notresult in a significant difference in the severity of the postthoracotomy pain and stress response in all groups. Based on our results,we suggest that epidural levobupivacaine combined with morphine provides an effective and safe analgesia and can partially suppresssurgical stress response.