Post-Thoracotomy Pain: Review Article

Abstract

Background: Thoracotomy is a very painful surgical procedure that is used to get access into the pleural space, to the lungs, to the heart, to the esophagus or to get access to the thoracic aorta or anterior mediastinum. Objective: To study different modalities of treatment used for post thoracotomy pain control. Recent Findings: Inadequate post-thoracotomy analgesia enhances the postoperative stress response with deleterious effects on respiratory, cardiovascular, gastrointestinal, urinary, immune and coagulation systems. In addition to anxiety and increased risk of Post Thoracotomy Pain Syndrome (PTPS), which can interfere with normal life and may persist for years or even for life? Conclusion: Providing adequate post-thoracotomy analgesia can be challenging, as patients are often elderly or having multiple comorbidities. A multimodal approach is considered in managing post-thoracotomy pain starting with preemptive analgesia and cognitive behavioral modalities in addition to conventional multimodal systemic regimens as opioids, acetaminophen, NSAID, cyclooxygenase (COX)-2-specific inhibitors, gabapentin and pregabalin, steroids, IV lidocaine infusion, ketamine, and many regional analgesic modalities to avoid or decrease adverse effects of systemic regimens. These regional analgesic modalities include thoracic epidural blocks, thoracic paravertebral blocks, intrathecal opioid analgesia, serratus anterior plane blocks, intercostal nerve blocks, interscalene block, erector spinae block and interpleural block.

Value of Combining Intercostal Block by the Operating Surgeon with Other Pain Control Modalities on Post-thoracotomy Pain Management

“…The results of our study are in agreement with the results of the systematic review done by Badawy et al (16) who found that a multi-modal approach should be considered in the management of the post-thoracotomy pain starting even before the surgical trauma such as preemptive analgesia and the cognitive behavioral modalities.…”

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

“…Pain after thoracotomy is more severe and hemodynamic parameters are affected at a higher rate compared to other abdominal surgical interventions because of the extensive distribution of the intercostal nerves and incision of more muscle mass (Gad-Allah et al, 2021;Mesbah et al, 2016). Hypothermia, considered a frequent problem in the first postoperative hours, leads to feelings of cold, deterioration in thermal comfort, shivering, and pain (D. Kim, 2019;Riley & Andrzejowski, 2018).…”

“…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).…”

Maximum Pain at Rest in Pediatric Patients Undergoing Elective Thoracic Surgery and the Predictors of Moderate-to-Severe Pain—Secondary Data Analysis

“…Acute pain after thoracic surgery can caused by skin incisions, muscle splitting, intercostal nerve damage, pleural damage, chest drain insertion, retraction/resection/fracture of the ribs, or dislocation of the costovertebral joints [6]. Pediatric patients undergoing thoracic surgery show higher pain scores compared with those undergoing abdominal or extremity surgery [7].…”

“…Pediatric patients undergoing thoracic surgery show higher pain scores compared with those undergoing abdominal or extremity surgery [7]. Poorly treated pain in these patients can result, among other things, in atelectasis and pneumonia due to difficulty breathing deeply and coughing [6]. In addition, insufficient pain relief in the first 24 h after thoracic surgery is a risk factor for chronic pain [8].…”