Preventing Post‐Thoracotomy Pain Syndrome

Abstract

This article provides a concise overview of post‐thoracotomy pain syndrome, describes anesthetic and surgical factors that have been investigated to reduce the incidence of the syndrome, and explores the effectiveness of various treatments for this condition. Although some interventions (both procedural and pharmacologic) have been investigated in both preventing and treating post‐thoracotomy pain syndrome, definitive studies are lacking and firm conclusions regarding the benefit of any intervention cannot be drawn. The problem is compounded further by our lack of understanding of the pathophysiologic mechanisms underlying the development of chronic pain after surgery. Going forward, it will be important to elucidate these mechanisms and conduct well‐designed trials involving novel therapeutic agents for both prevention and treatment of post‐thoracotomy pain syndrome. Mt Sinai J Med 79:133–139, 2012. © 2012 Mount Sinai School of Medicine

Impact of Pregabalin on the Occurrence of Postthoracotomy Pain Syndrome

“…[1][2][3] It has a reported prevalence of 60% to 65% 6 months to 1 year after the surgery. 1,[4][5][6][7] The International Association for the Study of Pain defines PTPS as pain that recurs or persists along a thoracotomy scar longer than 2 months after surgery.…”

“…2). Patients in the placebo group had their chest tubes and epidural catheter removed earlier than patients in the pregabalin group (4 days [3][4][5] vs 5 days [3][4][5][6], respectively; P = 0.03). Intravenous equivalent hydromorphone consumption was comparable between groups, except at 96 hours where it was significantly lower for the pregabalin group.…”

The Qualitative Hyperalgesia Profile: A New Metric to Assess Chronic Post-Thoracotomy Pain

“…with shallow breathing, and also has a pronounced movement-related component during coughing, stretching or twisting, an example of mechano-hyperalgesia [26–28]. Debate has centered around the frequency with which this pain can be classified as neuropathic [22, 29–31] and intentional modifications in surgical procedures have reduced the incidence of chronic pain [28, 32–36], primarily by lowering the likelihood of intercostal nerve damage [37–41]. A variety of local and other anesthetic methods have also been shown to reduce post-thoracotomy pain [24, 42–46], but the mechanisms of effect here are not obvious since such drugs are known to act on multiple different targets [47].…”

Comparison of epidural and single-shot paravertebral block analgesia after thoracotomy

“…En şiddetli ağrı tiplerinden birisi olan akciğer rezeksiyonu sonrası akut torakotomi ağrısının etkin tedavisi, hasta rahatlığı ve postoperatif pulmoner komplikasyonları en aza indirmek için önemlidir [5][6][7][8] . Postoperatif ağrı yönetiminde, hasta özellikleri, ağrının şiddeti ve beklenen süresi ile seçilecek yöntemin hastaya getireceği riskler dikkate alınmalı ve analjezi yönte-mi anestezi uygulamasının bir parçası olarak mutlaka anestezi öncesinde planlanmalıdır [9,10] .…”

“…Ciddi pulmoner komplikasyonları engellemek ve torakotominin uzun süreli komplikasyonlarından olan postoperatif kronik ağrıyı önlemek için pek çok strateji tanımlanmıştır [5,6] . Çalışmamızda, akciğer rezeksiyonu için torakotomi uygulanan olgularda, postoperatif ağrının giderilmesi amacıyla, torakal epidural analjezi (EA) ile torakal paravertebral blok analjezisinin (PA) postoperatif ağrı ve hemodinamik yanıtlar üzerindeki etkilerinin karşılaştırılmasını amaçladık.…”