Objectives
To evaluate the analgesic yield of thoracic epidural (TE) analgesia using bupivacaine in
combination with dexamethasone, clonidine versus fentanyl for thoracotomy patients.
Patients and methods
Sixty patients were divided into four equal groups, which received TE analgesia
immediately at end of surgery during skin closure using bupivacaine either alone
(C group) or in combination with dexamethasone (S1 group), clonidine (S2 group),
or fentanyl (S3 group). Postoperative (PO) pain was measured using a visual analogue
scale (VAS); rescue analgesia (50 mg mepridine) was given when a patient had a VAS
score of 40, and the duration of analgesia and the total mepridine doses consumed
were determined during 24-h postoperatively. Verbal rating scores were used for the
evaluation of PO sedation and nausea and vomiting (PONV).
Results
The mean duration of analgesia was significantly longer in the study groups compared
with group C, with a significantly longer duration in the S1 group compared with the
S3 group. The mean 24-h cumulative pain VAS score and the total PO rescue
analgesia consumed were significantly lower in the S1 group compared with the other
groups and in the S2 group compared with group C. Both S2 and S3 groups showed
significantly higher frequency of higher sedation scores compared with the C and S1
groups. The frequency of patients who had a PONV zero score was significantly higher
in the S1 group compared with the other groups, with a nonsignificant difference
among the other groups.
Conclusion
TE analgesia using bupivacaine with clonidine or dexamethasone is an efficient
therapeutic modality for post-thoracotomy pain. Dexamethasone as an adjuvant
provided more prolonged PO analgesia, with a reduction of rescue analgesia
consumption without PO sedation, and spares the use of antiemetics for PONV that
was minimized in frequency and severity |
