Post thorocotomy pain delays recovery and increases the postoperative morbidity. The anguish caused by thoracotomy is gruelling to patients with toilsome postoperative pain. The incision in thoracotomy is extremely painful as it involves resection of rib and muscle cutting incisions. Therefore pain following thoracotomy is of serious concern. The acute incissional pain in thorocotomy impedes the chest wall expansion and cough reflex leading on to accumulation of secretions, ventilation perfusion mismatch, atelectasis , hypoxia , infection thereby delaying the recovery. 

                            Thoracic epidural analgesia is a common modality for providing pain relief in patients undergoing thoracotomy. Other methods of analgesia used as a part of multimodal analgesia regimen are intravenous, intrathecal or epidural narcotics, NSAIDS, lumbar epidural block, paravertebral block,  intercostal nerve block, intrapleural analgesia , cryoanalgesia, and transcutaneous nerve stimulation. Multimodal analgesia techniques along with multidisciplinary rehabilitation program may enhance postoperative recovery, decrease the duration of hospital stay, and facilitate early convalescence. Multimodal analgesia provides superior dynamic pain relief with reduced analgesic-related side effects.  Many researchers have found that the use of adjuvants like fentanyl, morphine , clonidine , ketamine, ketorolac  with epidural local anaesthetics increases the efficacy of epidural analgesia and decreases the side effects .

                            Clonidine and dexmedetomidine are two α₂-agonists used as an intravenous anaesthetics. Dexmedetomidine is eight times more α₂ selective  than clonidine .Dexmedetomidine has been recommended for use as a sedative in patients on mechanical ventilation in Intensive care unit. The use of intravenous dexmedetomidine for has been found to reduce the requirement of opioid analgesia and also improve hemodynamic stability. It provides anxiolysis and sedation without respiratory depression.  Patients are sedated but arousable following use of dexmedetomidine. It also provides haemodynamic stability and attenuates the increases in heart rate and stress response during intubation and emergence of anesthesia. It reduces stress response to surgery and provide perioperative cardio protection in patients having coronary risk factors. Recently dexmedetomidine due to these various advantages is used as an adjuvant analgesic in various vascular, bariatric and thoracic surgeries. Other routes like epidural dexmedetomidine also have been tried by few researchers. They have found that the use of dexmedetomidine through epidural route  also reduces the postoperative morphine requirement ¹⁹.