LETTERS TO THE EDITOR: Letters & Announcements
To the Editor:
I read with interest the study by Bloch et al. (1). I have some questions about the study. First, why did the authors choose to have a thoracic epidural catheter inserted, and then not give any local anesthetics through it in the postoperative period? Might not the results have been somewhat different if an intravenous infusion of tramadol had been compared with epidural local anesthetic plus morphine instead? I say this because in my experience, epidural morphine alone is notoriously inadequate for postthoracotomy pain relief.
Second, I was somewhat disappointed that there was no comparison made between the groups with respect to postoperative nausea and vomiting, since this is obviously a common problem in all patients who receive opioids or tramadol. I am wondering if the lack of difference shown in the requirements of rescue analgesics between the tramadol and epidural morphine groups might not indicate that the two modalities were equally unsatisfactory at pain relief.
Finally, the risk-benefit ratio for inserting a thoracic epidural catheter, then infusing with local anesthetic and opioid might be more acceptable compared to inserting the catheter and then only giving epidural opioid alone.
S.K. Chua, FHKCA, FHKAM(Anaes)
1. Bloch M, Dyer R, Heijke S, James M. Tramadol infusion for postthoracotomy pain relief: a placebo-controlled comparison with epidural morphine. Anesth Analg 2002; 94: 523–8.