Please confirm that an ethics committee approval has been applied for or granted: Not relevant

Background and Aims Thoracotomy is a painful surgical intervention characterized by a high incidence of chronic pain that can be reduced with an aggressive analgesic therapy, justifying the use of thoracic epidural analgesia with opiates and local anesthetics for their efficacy and the relatively high benefits, Unilateral intercostal nerve blocks are quick and simple. Single injection for two or three intercostals spaces. Xylocaine patch application can be a powerful analgesic adjunct to existing analgesic agents

Methods Control intercostal group (Group I, n=20): Patient in this group will receive a dose of 5 ml bupivacaine 0.5% peri-neurally in each space. - Xylocaine patch (Group xylo, n=20): Patients in this group will receive xylocaine patch. Two patches to applied for each patient for 24 hours then to be removed. When sufficiently awake for pain assessment VAS at 2, 4, 6, 8, 12, 16, 24 hours postoperatively. The time to the first request of rescue postoperative analgesic will be: ‘the time interval between the onset of recovery and the first request to postoperative analgesia’. Cumulative 24 hours analgesic consumption of and morphine will be recorded. Ramsay score for assessment of sedation at the same intervals for VAS.

Results there was significant difference in the first rescue analgesia with more than 8 hours postoperative in xylo group and only 2 hours in I group. total amount of opioids consumed in 24 hours following surgery in xylo group was significantly lower than the other group

Conclusions xylocaine patch is an effective non invasive alternative in control of post thoracotomy pain.