Duloxetine Role in Reducing Opioid Consumption After Thoracotomy

Inclusion criteria

• ASA I, II, and III patients scheduled for thoracotomy for pleural or lung cancer resection.
• Age above 18 years & less than 65 years.
• Adequate coagulation function within 30 days of surgery, defined as platelet count 100,000/mL or more, INR≤ 1.5, and partial thromboplastin time ≤40 seconds.

Exclusion criteria

• Allergy to duloxetine or to local anesthetics.
• Patients with educational, psychiatric (untreated or poorly controlled schizophrenia, major depression, or bipolar disorder), or communication (language) barriers that would prevent understanding of the informed consent & preclude accurate assessment of postoperative pain and/or ability to answer questions about pain.
• Patients with severe renal and/or liver disease.
• History of chronic pain, long term narcotic use and/or antidepressants.
• Reasons for exclusion after randomization will be protocol violations or patient request.
• Fever, evidence of infection, or other coexisting medical conditions that would preclude epidural placement.