Objectives: To evaluate the analgesic yield of thoracic epidural (TE) analgesia using bupivacaine in combination with dexamethasone, clonidine versus fentanyl for thoracotomy patients.
Patients & Methods: Sixty patients were divided into 4 equal groups 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 visual analogue scale (VAS), rescue analgesia (50 mg mepridine) was given when patient has VAS score of 40 and duration of analgesia and total consumed mepridine doses were determined during 24-hours PO. Verbal rating scores were used for evaluation of PO sedation and nausea and vomiting (PONV).
Results: Mean duration of analgesia was significantly longer in study groups compared to group C with significantly longer duration recorded in S1 group compared to S3 group. Mean 24-hr cumulative pain VAS score and total consumed PO rescue analgesia were significantly lower in S1 group compared to other groups and in S2 group compared to group C. Both S2 and S3 groups showed significantly higher frequency of higher sedation scores compared to C and S1 groups. The frequency of patients had PONV zero score was significantly higher in S1 group compared to the other groups with non-significant difference among other groups.
Conclusion: Thoracic epidural 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 reduction of rescue analgesia consumption without PO sedation and spares the use of antiemetics for PONV that was minimized in frequency and severity.
Keywords: Thoracic epidural, Dexamethasone, Clonidine, Fentanyl, Post-thoracotomy pain