Postoperative analgesia by epidural methylprednisolone after posterolateral thoracotomy

The aim of this study was to evaluate the potential analgesiceffect of epidural methylprednisolone (MP) after posterolateralthoracotomy (PLT). Adult male patients undergoing PLT for lungsurgery were included in a prospective, randomized, double blindstudy. Peroperative analgesia (bupivacaine plus sufentanil)was given by a thoracic epidural catheter associated with generalanaesthesia. After surgery, patients received either MP 1 mgkg^–1 followed by a continuous epidural infusion of MP1.5 mg kg^–1 during 48 h (MP group) or 0.9% saline as abolus injection and continuous epidural infusion (P group).Additional morphine analgesia was administered by i.v. patient-controlledanalgesia. Pain was assessed at rest and with mobilization every4 h after operation during 48 h with a visual analogue scale(VAS). The primary end-point was the total morphine requirementsduring the 48 first postoperative hour. Twenty-four patientswere allocated to MP (n=12) and P (n=12) groups. Characteristicsof the two groups were similar. There were no differences betweengroups for morphine requirements (median and interquartile range)during the 48 h: 59 mg (40–78) in MP group vs 65 mg (59–93)in P group. There were no differences between groups for morphinerequirements every 4 h during the 48 h and VAS for pain at restand evoked pain. No side effects were reported. It was concludedin this small study that these results did not support the useof epidural steroids for postoperative analgesia after PLT. Br J Anaesth 2001; 87: 635–8