Sixty patients with ASA class I and II, 20-80 years who will candidate for esophagus cancer with Transhiatal method surgery, randomly divided into two groups of 30:
The F group = Trans-dermal Fentanyl patch and the M group = intravenous morphine
An exclusion criterion is patients who have history of allergy to narcotics.
The anesthetic method is the same in both groups. In Fentanyl group (F), a Trans-dermal Fentanyl patch 50µg/h will administer one hour prior to anesthesia induction on anterolateral skin of the thorax. In M group, after the operation, 4 mg of morphine will inject every 6 hours.
After tracheotomy, the patients is transfer to ICU and their entrance time to ICU is consider as the time zero and they will monitor for 72 hours afterwards.
Pain score of the patients will record throughout the next 72 hours after thoracotomy in o, 2, 4, 6 and every 6 hours afterwards and a minute prior to morphine injection. The pain score evaluate by using visual analogue scale, (0-10 number). In case of need for adequate analgesia, with a VAS more than 4, 4 mg of intravenous morphine will inject in both groups.
At the end of the study we compare the mean amount of morphine and VAS in the two groups.
We will record Vital signs such as systolic, Diastolic blood pressure, heart rate, respiratory rate every 6 hours in the ICU.
We will record demographic data such as age, sex, weight and duration of surgery.