Dr. Rizk Abd El hakeem Mohamed El azhary :: Publications:

Thoracic epidural analgesia has been considered to have a good anesthetic efficacy and to decrease postoperative pain and complication rate. Aim of the work was to compare the efficacy and adverse events of continuous thoracic epidural infusions to reach the best combination in controlling acute pain after thoracotomy Material and methods: This study was done at Benha faculty of medicine hospital on 60 adult patients of ASA physical status I, II, and III were scheduled for thoracotomy operations. All patients ranging in age from 20 – 70 years, and their weight ranging between 30-120 kg. Patient with infection in the puncture area or having coagulation disorders or any of the absolute contraindications of thoracic epidural were excluded from the study. No premedication was given, only explanation of the procedure and psychological support, the epidural catheter was placed preoperatively. All patients received 6ml/h of their combination Patients were divided into three equal groups; each group consists of 20 patients (10 males and 10 females) according to the drug used for epidural infusion for post-thoracotomy pain relief as follows: • Group M: (Bupivacaine 0.125% + Magnesium sulfate 2% aiming at to infuse 100 mg/h i.e. 100mg/6ml). • Group F: (Bupivacaine 0.125% + Fentanyl citrate 2g/ml conc.). • Group N: (Bupivacaine 0.125% + Neostigmine methyl sulfate 7g/ml conc.). All the following data recorded starting from the third hour after the operation then the fourth hour, the eighth hour, the twelfth hour, and lastly the twenty four hour 1- Hemodynamic parameter: Arterial blood pressure (ABP) mmHg (systolic and diastolic), and Heart rate (HR) beat/min. 2- Respiratory parameter: Respiratory rate (RR) , and Arterial blood gases (ABG) 3- Level of analgesia: Numerical verbal rating scale (NVRS), and Visual analogue scale (VAS). 4- The level and quality of sedation: by Ramsay sedation scale Results and conclusion: In comparing group F with group M, it was found that: Group F is superior to group M as regard to better hemodynamic stability, better respiratory parameters, better pain scores, better sedation scores, and lower rate of complications. * In comparing group F with group N, it was found that: Group F is superior to group N as regard to better hemodynamic stability, better respiratory parameters, better pain scores, better sedation scores, and lower rate of complications. * In comparing group M with group N, it was found that: Group N is superior to group M as regard to better hemodynamic stability, better respiratory parameters, better pain scores, better sedation scores but group M had a lower number of complicated patients than that in group N. So if we arrange and put the three groups in order scheme; we will find that group F > group N > group M. According to this order we can say that the addition of fentanyl to bupivacaine and the infusion of their combination (fentanyl 2ug/ml + bupivacaine 0.125%) in the thoracic epidural catheter is the best combination in controlling acute postthoracotomy pain.