Dexamethasone as an adjuvant to thoracic epidural provided more prolonged analgesia for post-thoracotomy pain than clonidine and fentanyl

Objectives To evaluate the analgesic yield of thoracic epidural (TE) analgesia using bupivacaine incombination 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 (50mg 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 theevaluation 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 S1groups. 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 efficienttherapeutic 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.