Analgesic effects of combined regular acetaminophen drip infusion and constant fentanyl infusion after thoracotomy

Abstract

Objective) To investigate whether the combined use of a regular drip infusion of acetaminophen and constant fentanyl infusion could replace epidural anesthesia after thoracotomy.

Methods) We conducted a retrospective cohort study of patients receiving pain relief after thoracotomy procedures. Cases were classified into two groups based on the method of pain relief: an acetaminophen and fentanyl group (AF group) and epidural anesthesia group (Epi group). We compared and examined the analgesic effect and drug side-effects for each group.

Results) A total of 44 cases were included in the final analysis (AF group: 19 cases, Epi group: 25 cases). Compared with epidural anesthesia, the analgesic effect of combined acetaminophen and fentanyl was high, and only inferior with respect to coughing on postoperative day 1. The delay in getting out of bed following surgery did not differ between groups. However, during rehabilitation, a significantly larger drop in the blood pressure was observed in the Epi group, whereas nausea and vomiting were more frequent in the AF group. These side-effects caused a short delay in rehabilitation for both groups.

Conclusions) The combined use of a regular drip infusion of acetaminophen and constant fentanyl infusion had a comparatively high analgesic effect, although additional measures may be required to alleviate nausea, vomiting, and pain while coughing. Furthermore, the prevention of epidural complications, reduction of the anesthesia induction time, and an analgesic effect that is not dependent on the skill of the anesthesiologist can be expected. Therefore, this approach is an effective method for pain relief following thoracotomy procedures.