RESUMEN
Transthoracic endoscopic sympathectomy [TES] has been already a standard method for the treatment of primary hyperhydrosis. Postoperative pain is a problem that usually encountered during TES. Although the surgical procedure is simple and short, the pain is usually severe [Failor and Capell, 2003]. This study was performed in 57 patients of both sex, aged 11-48 years old, divided randomly into three groups. All patients were premedicated with intravenous midazolam 0.02mg/kg. Anesthesia was induced with sleeping dose of thiopentone sodium, lug/kg fentanyl and atracurium 0.5mg/kg to facilitate endotracheal intubation. We evaluated the effect of three methods of management of postoperative pain. I [n=20] was treated by IV pethidine starting with 1mg/kg pethidine with top up doses of pethidine when needed. Group II [n=19] was treated by intrapleural plain bupivacaine 0.25% 1mg/kg. Group III [n=18] was treated by local infiltration of 0,5% plain bupivacaine 2 ml at both sides of cut ends of the sympathetic chain. In conclusion, we found that the systemic use of pethidine was least satisfactory and the intrapleural of injection bupivacaine was the best. However the time to discharge from hospital was the same for all groups