Epidural methadone for acute post-thoracotomy pain: An alternative to a ropivacaine plus fentanyl-based patient-controlled epidural regimen

SummaryAccurate management of acute post-thoracotomy pain can be obtained with epidural local anaesthetics with or without opioids. The routine in our centre for many years has been boluses of epidural methadone with satisfactory results and a lack of serious complication.Objectives To compare the analgesic effectiveness of two epidural regimens for acute post-thoracotomy pain management.Methods We enrolled 49 patients undergoing lung resection by thoracotomy in a prospective, non-blinded open study. Study groups: 25 patients received a patient controlled epidural (PCEA) regimen of 0.16% ropivacaine plus 3.5 μg ml−1 fentanyl, and the other 24 patients receiving 4–6 mg of epidural boluses of 0.1% methadone every 8 h.Results Both regimens provided similar pain relief during the first two postoperative days, however, patients receiving methadone needed less rescue analgesia and presented fewer numbers of hypotensive events compared to PCEA patients.Conclusions Epidural boluses of methadone are as a safe and adequate analgesic regiment as a PCEA with ropivacaine plus fentanyl for post-thoracotomy pain management. Additionally, the cost of our current technique is much lower than the ropivacaine infusion.