Mitigating the Impact of Acute and Chronic Post-thoracotomy Pain

A randomized trial of erector spinae plane block for analgesia after video-assisted thoracoscopic surgery

“…Rib retraction, separation of the costovertebral joints, tissue traction, incision and suture, visceral and intercostal nerve injuries, chest tube stimulation, postoperative cough and respiratory stimulation are all pain sources of thoracic surgery, thus making it one of the most painful operation among all kinds of surgeries [5][6][7][8]. Postoperative pain is the primary factor affecting postoperative recovery of thoracic surgery patients: Short-term adverse effects includes respiratory depression, atelectasis, pulmonary infection, neuroendocrine disorders of urinary retention and dyssomnia; long-term chronic pain can even cause the change of patient's personality and behavior, which seriously affect patients' daily life [9][10][11]. So effective postoperative analgesia is an important component of thoracic ERAS.…”

Post-thoracotomy pain syndrome and sensory disturbances following thoracotomy at 6- and 12-month follow-ups

“…The emphasis in previous research has been on reporting the prevalence of persisting pain and risk factors. Intercostal nerve injury has been proposed as a cause of PTPS, and previous studies have focused on investigating the neuropathic pain component to understand the underlying mechanisms better 6–10. Recent studies have used the expressions “sensory changes” or “disturbances” rather than “neuropathic pain component” 11,12.…”

“…From a sample of 955 patients reporting no sensory disturbances in 2008, 164 (17%) reported them at the 6-year follow-up. The simultaneous occurrence of pain and sensory disturbances caused by nerve injury is one pathogenic mechanism believed to cause PTPS 6. However, sensory disturbances are not always associated with pain 15.…”

Pain Control in Thoracic Surgery

“…Vital kapasite ve fonksiyonel rezidüel kapasitede azalmalar atelektaziye zemin hazırlayabilir ve ventilasyon/perfüzyon uygunsuzluğu postoperatif dönemde hipoksemi ile sonuçlanabilir. Bu nedenle, toraks cerrahisi sonrası hasta derlenmesi ve rehabilitasyonunu olumsuz yönde etkileyen akut ağrı, kontrol altına alınmalıdır (1,2).…”

“…Üç aydan daha fazla süre ile devam eden ağrı, kronik posttorakotomi ağrısı olarak tanımlanır. Farklı çalışmalarda kronik ağrı oranı % 30-80 arasında bildirilmektedir (2). Bunların %5'i ciddidir ve yaşamı olumsuz düzeyde etkiler (35).…”