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Epidural Steroid and Clonidine for Chronic Intractable Post-thoracotomy Pain: A Pilot Study

Authors


Address correspondence and reprint requests to: Amany E. Ayad, MD, FIPP, Anesthesia and Pain, Cairo University, Corniche El Manial Cairo Cairo 12345, Egypt. E-mail: amanymounir@yahoo.com.

Abstract

Background:  Chronic post-thoracotomy pain is relatively common after major thoracic surgery. The primary results of a pilot study using thoracic epidural steroid and clonidine injection to treat chronic intractable post-thoracotomy pain are presented.

Methods:  Twenty-one patients with intractable post-thoracotomy pain participated in the study. Thirteen patients received thoracic epidural injection of a mixture of 150 μg clonidine and 80 mg of methylprednisolone acetate diluted in 8 mL 0.5% lidocaine. Eight patients continued with comprehensive medical management and served as a control group. A visual analog scale (VAS) for pain was recorded before treatment, 30 minutes after the epidural injection and before discharge, at 3 weeks and 6 months. Pain, sleep disturbances, appetite changes and daily activity, as well as the incidence of complications were recorded. The need for opioid rescue medications was recorded.

Results:  Twelve of 13 patients in the injection group reported improvement (> 50% reduction of pain) at 3 weeks and 6 months following the injection. Allodynia improved in all injection group patients compared to four of eight in the control group. Sleep disturbance, appetite changes and daily activity were improved in the injection group. The number of patients requiring opioid rescue medications was reduced from 61.5% to 15.3% during the 6-month duration of study. Injection caused transient hypotension in 46.2% of patients. Mild sedation was noted in 30.7% of patients receiving injection; 15.3% of the patients had localized back pain at the site of injection.

Discussion:  Our preliminary data suggest possible efficacy of thoracic epidural steroid and clonidine mixture in the treatment of chronic post-thoracotomy pain. No serious adverse effects were noted in this pilot study. ▪

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