Post operative pain management in thoracic surgery is necessary to avoid complications. In some cases that have no possibility of epidural catheter insertion, it is extremely important to determine other effective regional methods according the origin of acute pain to prevent post operative pain. Therefore, comparative effectiveness of Epidural, Intrapleural, sub pleural and incisional catheter insertion can evaluate quality and quantity of pain control, complications and drug consumption to introduce the appropriate methods for pain control after lateral Thoracotomy.
Numbers of samples (120 patients) are randomly divided into equal four groups. In group (A) epidural catheter at the level of 6 T -8T is placed and 10mililitter bupivacaine 0.25% as bolus dose administered. Induction of anesthesia with Fentanyl, Midazolam, Propofol, Cisatracurium is performed. Maintenance with Propofol and Remifentanyl (TIVA) continued. At the end of surgery muscle relaxant reversed and patients extubeted. Then catheter attached to the Autofuser pump by rate of 2 milliliter per hours Bupivacaine 0.25% infusion. After awaking, the patient transferred to the ICU .Pain score and Opioid (Morphine or Pettedin) needs are recorded since 2 - 6 - 12 - 24 and 48 hours in post operative period. In group (B), instead of epidural catheter, sub pleural (Para Vertebral) catheter is placed at the level of (6T-8T) and 10 milliliter bupivacaine 0.25 % as bolus is injected. Induction and maintenance of Anesthesia are the same; at the end of surgery muscle relaxant reversed and patient extubeted. Then catheter attached to the Autofuser pump by the same rate infusion. After awaking, recording protocol is the same above. In group C catheter located within the pleura (special technique) at the level of (6T-8T) and 10 milliliter Bupivacaine 0.25 % as bolus injected. Induction and maintenance of Anesthesia are the same; at the end of surgery muscle relaxant reversed and patient are extubeted. Then catheter attached to the Autofuser pump by the same rate infusion. After awaking, recording protocol is the same above. In group D, Bupivacaine 0.25% (10 milliliter) infiltrated to the site of surgery before incision then Induction and maintenance of Anesthesia is performed as the same above, at the end of surgery incisinal catheter is placed by surgeon then sutured and dressed. At last catheter attached to the Autofuser pump by the same rate infusion. After awaking, recording protocol is the same above. After collecting information, for parametric data; Independent T-test and for non parametric data; Mann-Whitney chi - square and Fisher exact test, analysis will be used.