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.