Cost-effectiveness of thoracic patient-controlled epidural analgesia using bupivacaine with fentanyl vs bupivacaine with morphine after thoracotomy and upper abdominal surgery

Songyos Valairucha, Pacharee Maboonvanon, Thanaporn Napachoti, Busara Sirivanasandha, Suwannee Suraseranuvongse
Journal of the Medical Association of Thailand 2005, 88 (7): 921-7

OBJECTIVES: To compare the effectiveness and cost of thoracic patient-controlled epidural analgesia (TPCEA) using bupivacaine with fentanyl (BF) vs bupivacaine with morphine (BM) solution.

MATERIAL AND METHOD: In a blinded, randomized controlled trial, 90 adult patients who were scheduled for thoracotomy or upper abdominal surgery were enrolled. All patients were anesthetized by a combined general/epidural technique. Intraoperative and postoperative analgesia was provided by TPCEA using bupivacaine 0.0625% with either fentanyl (group BF) or morphine (group BM) solution. The occurrence and severity of side effects, visual analogue scale (VAS) for pain at rest and during movement, patients' satisfaction score as well as charged cost of pain and side effect management were recorded for 48 hrs.

RESULTS: Demographic data of both groups were not significantly different. No statistical differences were noted with respect to efficacy of pain relief between the 2 groups. Only 28.5% of the patients in group BM required supplemental systemic analgesia within 24 hours after epidural catheter removal compared with 51.4% in the group BE Patients' satisfaction and the severity of epidural analgesia related side effects, using itching and nausea/vomiting score, of both groups were not significantly different except the median nausea/ vomiting scores of group BM at 18 and 24 hours were statistically higher than those of group BF (P = 0.047 and 0.02, at 18 and 24 hour respectively) but not clinically different. The mean charged cost of medication used in group BM (470.64 +/- 160.54 baht) was lower than that in group BF (814.15 +/- 217.51 baht).

CONCLUSION: TPCEA using BF and BM solution resulted in similar pain relief and side effect profiles but with higher charged cost of medication in group BF Morphine appears to be a more cost-effective choice than fentanyl for TPCEA after thoracotomy or upper abdominal surgery.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"