The effect of preemptive thoracic epidural analgesia on long-term wound pain following major thoracotomy

Abstract

To evaluate the effects of the performance of preemptive epidural analgesia in major thoracotomies on chronic postthoracotomy pain. Materials and methods: A total of 60 patients with ASA I-II status between the ages of 18 and 75 years who planned to have elective thoracotomy were randomized into 3 groups. In all cases, an epidural catheter was placed at the 6th–7th or 7th–8th thoracic intervals, preoperatively. Patients in the control group (n = 20) did not receive epidural analgesics before and during the operation, and preoperative analgesia was provided by remifentanil infusion. In the incision-sensitized group (n = 20), patients had remifentanil infusion preoperatively and 0.1% levobupivacaine (10-15 mL) was given through the epidural catheter 10 min after the surgical incision. Considering that epidural analgesia reached an adequate level 20 min after the injection, the remifentanil infusion was stopped. In the preemptive analgesia group, patients (n = 20) received 10-15 mL of 0.1% levobupivacaine at the 2nd dermatome superior and inferior to the incision dermatome through the epidural catheter for analgesia before anesthesia induction. The pain levels of the patients were evaluated at postoperative months 1, 3, and 6 using a visual analog pain scale. Results: When the pain of the patients in the chronic period were compared, no statistically significant difference was found among all 3 groups (P > 0.05). Conclusion: We suggest that thoracic preemptive epidural analgesia application before the incision is not superior to intraoperative or postoperative thoracic epidural analgesia in prevention or attenuation of chronic postthoracotomy pain after major thoracotomy operations.