Epidural Levobupivacaine-sufentanil Versus Epidural Levobupivacaine and Intravenous Ketamine

Thoracic Epidural Analgesia: Epidural Levobupivacaine and Sufentanil Versus Epidural Levobupivacaine and Intravenous Ketamine

Thoracic epidural analgesia is often proposed to thoracotomized patients. A local anesthetic and an opioid are generally associated to produce an epidural analgesia. However, opioid epidural administration is frequently associated with adverse effects as nausea, vomiting, urinary retention, ... On the other hand, iv ketamine has been demonstrated to be an effective analgesic.

The purpose of the study is to compare the epidural administration of levobupivacaine and sufentanil or the epidural administration of levobupivacaine associated with the iv administration of ketamine.

Inclusion Criteria:

• age between 18 and 75 yrs
• class ASA I, II or III
• lung surgery

Exclusion Criteria:

• Contra-indication to the achievement of epidural analgesia
• Preoperative chronic pain,
• Contra-indication to ketamine
• Hypersensitivity to ketamine or any excipients
• Uncontrolled hypertension,
• Stroke
• Heart failure
• Hepatic porphyria
• Contra-indication to sufentanil
• Hypersensitivity to sufentanil, opioids or any excipients
• Treatment with an opioid agonist-antagonist,
• Contra-indication to levobupivacaine
• Hypersensitivity to levobupivacaine, local anesthetics of the amide or any excipients
• Hypotension, shock