Perioperative pain management after thoracotomy

Abstract

Even though thoracotomy is associated with significant postoperative complications, a growing understanding of the underlying pathophysiology and advances in multimodal pain therapy concepts in this specific group of patients are promising improved postoperative outcomes and potential reduction of the incidence of persistent pain.

Preventing Post‐Thoracotomy Pain Syndrome

“…Furthermore, paravertebral blocks are not associated with serious neurologic complications and may be particularly useful when epidural placement is contraindicated, as in patients with a preexisting coagulopathy. 28,29 There is some evidence that use of paravertebral blocks may decrease the incidence of chronic pain after breast surgery, which is similar to PTPS due to the predominance of neuropathic features. However, the role of paravertebral blocks in preventing PTPS has not been investigated, but should be considered as a topic for future research.…”

Comparison of two concentrations of bupivacaine by continuous paravertebral infusion after thoracotomy with pulmonary resection: a double-blind, randomized clinical trial

“…Further, in a recent short communication, these same authors warned about a risk of systemic toxicity due to the high doses of LAs used in the PVB to achieve a good level of analgesia (11). Overall, given the results mentioned above, in our hospital PVB is highly recommended as an analgesic technique for thoracic surgery and is considered an excellent alternative to epidural analgesia (12). To date, however, the ideal combination of drugs for paravertebral analgesia has not been established.…”

“…Post-thoracotomy pain management should be based on continuous regional analgesia, either via thoracic epidural block (TEB) or paravertebral block (PVB), preferably started before surgery and maintained for 48-72 hours. The block should be used in combination with intravenous anti-inflammatory drugs and paracetamol, as well as neuromodulators (gabapentinoids), with opioids as rescue analgesia depending on the intensity of pain assessed using a visual analoge scale (VAS) throughout the postoperative period (6).…”

Comparison of thoracic epidural and paravertebral analgesia for postoperative pain control after thoracotomy

“…[1][2][3][4][5] Bu yöntem ile solunum depresyonu oluşturulmadan etkin analjezi elde edilmekte ve solunum volümleri-nin yeterli kullanımı sağlanarak pulmoner morbidite (atelektazi, infeksiyon, pulmoner yetmezlik) oranı düşürülmektedir. [1][2][3][4][5][6] Bununla beraber, epidural blok uygulaması duranın delinmesi, epidural apse ve spinal hematom gibi ciddi komplikasyonlara da neden olabilmektedir. [1] Paravertebral blok (PVB) seçilen dermatomlarda tek taraflı duyusal, motor ve sempatik sinir bloğu sağlayarak, epidural analjezi yönteminin hipotansiyon, idrar retansiyonu ve hatta solunum kaslarının zayıflığına bağlı solunumsal yan etkilerini engelleyebilmektedir.…”

“…[1][2][3][4][5][6] Bununla beraber, epidural blok uygulaması duranın delinmesi, epidural apse ve spinal hematom gibi ciddi komplikasyonlara da neden olabilmektedir. [1] Paravertebral blok (PVB) seçilen dermatomlarda tek taraflı duyusal, motor ve sempatik sinir bloğu sağlayarak, epidural analjezi yönteminin hipotansiyon, idrar retansiyonu ve hatta solunum kaslarının zayıflığına bağlı solunumsal yan etkilerini engelleyebilmektedir. [2][3][4][5][6][7][8] Spinal sinirlerin intervertebral foraminadan çıktıkları paravertebral alanda seçici olarak bloke edilmelerinin, post+operatif ağrının giderilmesinde epidural analjeziye alternatif olabileceği bildirilmiştir.…”