Pain relief following thoracoscopic sympathectomy for palmar hyperhidrosis: A prospective randomised double-blind study

Background: Acute pain management following thoracoscopic sympathectomy (TS) has been described in the literature. The combination of interpleural (IP) injection of bupivacaine and intramuscular injection. (I.M) NSAIDs has not been reported. Therefore we conducted this randomized controlled trial to compare this technique to other reported techniques described for postoperative analgesia following TS. Methods: 40 patients scheduled to have TS under general anesthesia for the treatment of hyperhidrosis were randomly allocated into 4 groups. Group 1 received 1.5 mg/kg b.w I.M pethidine at end of surgery. Group 2 received ketoprofen 100 mg I.M at end of surgery. Group 3 received 0.4 ml/kg b.w interpleural bupivacaine 0.5%. Group 4 received a combination of I.M ketoprofen (100 mg) in addition to interpleural bupivacaine (0.4 ml/kg). Postoperative pain was assessed using the 11-point numeric rating score (NRS) at 7 different intervals. First, immediately on admission to PACU, every 2 hours for the next 8 hours then at 12 and at 24 hours. Pain was assessed at rest, during deep inspiration and while coughing. ANOVA was used for statistical analysis and Chi-square test for comparing of the data where P values <0.05 were considered significant. Results: The NRS at rest was 3.2 (1.9), 2.4 (1.6), 3 (1.9) and 0.7 (0.9) at Groups 1, 2, 3 and 4 respectively with significant difference in Group 4 versus other Group (P<0.05) at 2 hours postoperatively and up to 24 hours postoperatively. The same trend was also found during maximal inspiration and while coughing. Opioid consumption in 24 hours was significantly reduced in Group 4 compared to other Groups. Conclusions: Combination of IP bupivacaine and I.M ketoprofen provided superior analgesia when compared to each modality alone and was better than intramuscular pethidine injection in terms of NRS and the consumption of rescue morphine postoperatively. Further studies are needed on large sample size to confirm our results.