• Aysu Hayriye Tezcan, Özgür Karakurt, Mehmet Ali Eryazgan, Semih Başkan, Dilşen Hatice Örnek, Ramazan Baldemir, Bülent Koçer, and Mustafa Baydar.
• Anesthesiology and Reanimation Department, Ankara Numune Education and Research Hospital, Ankara, Turkey.
• Sao Paulo Med J. 2016 Jul 1; 134 (4): 280284280-4.

Context And ObjectivePost-thoracotomy pain is a severe and intense pain caused by trauma to ribs, muscles and peripheral nerves. The current study aimed to compare subpleural analgesia (SPA) with thoracic epidural analgesia (TEA) in patients undergoing thoracotomy.Design And SettingRandomized study at Ankara Numune Education and Research Hospital, in Turkey.MethodsThirty patients presenting American Society of Anesthesiologists physical status I-III were scheduled for elective diagnostic thoracotomy. The patients were randomized to receive either patient-controlled SPA or patient-controlled TEA for post-thoracotomy pain control over a 24-hour period. The two groups received a mixture of 3 µg/ml fentanyl along with 0.05% bupivacaine solution through a patient-controlled analgesia pump. Rescue analgesia was administered intravenously, consisting of 100 mg tramadol in both groups. A visual analogue scale was used to assess pain at rest and during coughing over the course of 24 hours postoperatively.ResultsIn the SPA group, all the patients required rescue analgesia, and five patients (33%) required rescue analgesia in the TEA group (P < 0.05). Patients who received subpleural analgesia exhibited higher visual analogue scores at rest and on coughing than patients who received thoracic epidural analgesia. None of the patients had any side-effects postoperatively, such as hypotension or respiratory depression.ConclusionThoracic epidural analgesia is superior to subpleural analgesia for relieving post-thoracotomy pain. We suggest that studies on effective drug dosages for providing subpleural analgesia are necessary.

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