Preemptive epidural analgesia for post thoracotomy pain

ABSTRACT

Pain treatment before surgery can minimized pain after surgery, may reduce anaesthestic need during the procedure, and could minimized the risk of chronic pain conditions developing in long term [1]. The aim of this study was to determine if preemptive epidural analgesia performed before thoracotomy incision and during the operation reduces post operative pain. In this randomized, double -blinded placebo controlled study, Patients in the treatment group received 8 ml of 0.25% bupivacaine and 2mL of fentanyl [50micro g /ml] via the epidural route prior to skin incision, followed by an infusion of bupivacaine 0.1% and fentanyl 10 micro g/mL at 6ml/hr. while the control group received saline in the epidural. At the time of chest closure patients of both groups received 8 ml of 0.25% bupivacaine and 2 mL of fentanyl 50 micro g/ml via the epidural route. The patients in the treatment group had lower maximum pain scores in the first six hours postoperatively. In addition they required less isoflurane intraoperatively. No significant differences were noted after the first six hours. Preemptive thoracic epidural analgesia appeared to reduce severity of post -thoracotomy pain but did not extend beyond six hours postoperatively