Practice Advisory for Preoperative and Intraoperative Pain Management of Thoracic Surgical Patients: Part 1

Abstract

Pain after thoracic surgery is of moderate-to-severe intensity and can cause increased postoperative distress and affect functional recovery. Opioids have been central agents in treating pain after thoracic surgery for decades. The use of multimodal analgesic strategies can promote effective postoperative pain control and help mitigate opioid exposure, thus preventing the risk of developing persistent postoperative pain. This practice advisory is part of a series developed by the Society of Cardiovascular Anesthesiologists (SCA) Quality, Safety, and Leadership (QSL) Committee’s Opioid Working Group. It is a systematic review of existing literature for various interventions related to the preoperative and intraoperative pain management of thoracic surgical patients and provides recommendations for providers caring for patients undergoing thoracic surgery. This entails developing customized pain management strategies for patients, which include preoperative patient evaluation, pain management, and opioid use–focused education as well as perioperative use of multimodal analgesics and regional techniques for various thoracic surgical procedures. The literature related to this field is emerging and will hopefully provide more information on ways to improve clinically relevant patient outcomes and promote recovery in the future.

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“…Combinations of blocks may also be used, keeping in mind local anesthetic toxic dose limitations. Overall, these are safe, effective, and easy to perform techniques with a rapidly growing presence in thoracic surgery, 76 and they can provide an alternative approach when there are contraindications to thoracic epidural analgesia, such as anticoagulation concerns.…”