Medical Student Research Fellowship for Summer 2007
Mentor: Adebola Adesanya, MD.
Department: Anesthesiology and Pain Management
Room number: A2.202
Mail Code: 9068
Phone number: 214 590 7243
Project title: "A Randomized Controlled Trial of Thoracic Epidural Bupivacaine/Fentanyl versus Dexemedetomidine for Post Thoractomy Analgesia"
Human subjects IRB approved project number (where applicable): UT IRB # 8843
and VA IRB # 06-065
Animal subjects IRB approved project number (where applicable): n/a
Project Type (patient-based research, animal-based research, or basic research; this characterization is only to permit a general classification for grouping similar types of projects): patient-based research
Brief Description of Project:
The objective of the protocol is to compare thoracic epidural analgesia to
Dexmedetomidine infusion for pain control after thoracotomy for lung surgery.
Incisions accompanying thoracotomy results in significant pain and discomfort and may delay surgical recovery. It may also contribute to postoperative morbidity by impeding effective chest expansion, coughing and clearance of secretions, predisposing patients to ventilation/perfusion mismatch, atelectasis, hypoxemia and infection.
Continuous thoracic epidural analgesia is widely used and has been proven to
be superior to IV PCA with opioids with respect to overall pain relief and side
effects such as nausea and sedation However, thoracic epidural analgesia with
local anesthetic and opioid combination alone may be ineffective in achieving
complete pain control in up to 24% of patients. Although thoracic epidural analgesia
is considered a "gold standard" for providing pain relief after thoracotomy,
there are concerns regarding potential adverse effects particularly epidural
hematoma formation. Since the introduction of low molecular weight heparin,
the incidence of epidural hematoma following epidural analgesia has increased.
Other serious potential complications include dural puncture, direct spinal
cord trauma, transient neuropathy, spinal hematoma and infection (9, 10). In
addition, there are clinical situations (e.g. empyema, coagulopathy) when thoracotomy
is performed but epidural analgesia use is inappropriate or contraindicated.
There is therefore a need for a modality for delivering analgesia in post-thoracotomy
patients that is less complicated yet effective and safe. The Food and Drug
Administration has approved Dexmedetomidine, a parenteral, selective alpha 2-agonist
that induces anxiolysis and analgesia without causing respiratory depression.
It also causes a dose-dependent decrease in plasma norepinephrine and decreases
the stress response to surgery and intensive care procedures. It may provide
perioperative cardiac protection in patients with coronary risk factors). Dexmedetomidine
was recently shown to significantly decrease the need for morphine after general
anesthesia for major surgery. It was also found to be an effective adjunct to
thoracic epidural analgesia; decreasing opioid requirement and reducing respiratory
Our study seeks to assess and compare the analgesic efficacy and the occurrence of side effects of both pain control techniques.
Previous Research Activities or Publications with Medical Students:
Assisting Dr. Kevin Klein with data collection with medical students as part of the research team.
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