Pain Management in Thoracic Surgery

The Effectiveness of Active External Warming of Patient Concurrently With Ice Application on the Incision Site on Post-Thoracotomy Pain and Analgesic Consumption

“…Thoracotomy is the first step in thoracic surgeries including pneumonectomy, lobectomy, lung segment resection, biopsies, and decortication or to get access for thoracic exploration in major trauma (Gad-Allah et al, 2021). Thoracotomy usually involves a skin incision in the fifth intercostal space, muscle dissection to variable degrees, and costal retraction (Kohli & Jain, 2020). Costal retraction during thoracotomy creates pressure on the intercostal nerves and may cause acute intercostal neuritis.…”

“…Post-thoracotomy pain is a multi-origin superficial acute traumatic pain caused by soft tissue injury, inflammation, muscle and visceral damage, and bone and joint trauma (Kohli & Jain, 2020). It occurs as a result of nociceptive and neuropathic mechanisms resulting from the somatic and visceral afferent nerves and is transmitted in three ways: (1) stimuli coming from the chest wall structures and most of the pleura are carried by intercostal nerves, (2) stimuli caused by diaphragmatic pleura go through the phrenic nerve, and (3) stimuli coming from the lung, mediastinum, and mediastinal pleura are carried by the nervus vagus (Kohli & Jain, 2020; Mesbah et al, 2016).…”

“…Thus, more than one potential pain pathway should be blocked simultaneously for synergistic and qualitative pain control. It is stated that a safe multimodal approach needs the use of regional analgesia techniques along with systemic opioids or non-opioid analgesics and their supplementation with other adjuvants when required (Kelsheimer et al, 2019; Kohli & Jain, 2020). Thus, an effective approach to acute pain management involves both pharmacological and non-pharmacological treatments.…”