Intrathecal Analgesia Versus Thoracic Epidural Analgesia for Thoracic Surgery

Abstract

Introduction: Thoracic surgery is associated with severe postoperative pain involving parietal, visceral, and projected components. Potent analgesia at rest and during movement over an extended period is crucial. Thoracic epidural analgesia is considered the gold standard, but intrathecal analgesia may represent a promising alternative. This study aimed to evaluate the ability of intrathecal analgesia to provide comparable pain relief to thoracic epidural analgesia for thoracic surgery. Methods: This prospective, descriptive study was conducted over 12 months. Adult patients undergoing elective thoracic surgery were included after obtaining written informed consent. Patients were randomly allocated to receive either thoracic epidural analgesia (Epidural group, n=40) with a loading dose of 10 ml 0.1% bupivacaine + 10 mcg sufentanil followed by continuous infusion, or intrathecal analgesia (Intrathecal group, n=23) with a single injection of 500 mcg morphine + 10 mcg sufentanil. Standardized general anesthesia and postoperative care protocols were applied. Primary outcomes included intraoperative hemodynamics, postoperative pain scores (NRS 0-10), rescue analgesic requirements, patient satisfaction, and adverse effects. Results: The incidence of intraoperative hypotension was higher in the Epidural group (30% vs 8.7%, p=0.04). Postoperative pain scores were initially lower in the Intrathecal group, but the difference was not significant beyond 18 hours. Rescue morphine requirements were significantly higher in the Epidural group during the first 12 postoperative hours. Overall patient satisfaction was higher in the Intrathecal group (82.6% vs 62.5%, p=0.03). The incidence of nausea/vomiting and pruritus was significantly higher in the Intrathecal group. Discussion: Thoracic epidural analgesia was associated with a higher risk of intraoperative hypotension, likely due to the extended sympathetic blockade. Intrathecal analgesia provided superior early postoperative ....