Pain Management After Thoracic Surgery

Abstract

Thoracic surgery can cause significant pain and suffering. Appropriate analgesia is important both for humanitarian reasons and to allow early mobilization and pulmonary rehabilitation. Poor pain relief can increase pulmonary complications and mortality. Pain after thoracic surgery is generated from multiple structures and is transmitted via a number of afferent pathways. Factors that affect pain postoperatively can be divided into patient factors, analgesic technique, and surgical approach. Paravertebral catheters and thoracic epidural analgesia are widely used for thoracotomies and both have advantages and disadvantages. Recent studies suggest a similar quality of pain relief between the two approaches but a preferable side effect profile where paravertebral analgesia is utilized. Opioid-tolerant patients pose a particular challenge. Maintenance opioid should be continued perioperatively to avoid withdrawal symptoms. A multimodal technique involving regional blocks and supplemented with non-opioid analgesics is advised.