Trends and New Evidence in the Management of Acute and Chronic Post-Thoracotomy Pain—An Overview of the Literature from 2005 to 2015

The Effect of Dexmedetomidine on the Acute Pain After Cardiothoracic Surgeries: A Systematic Review

“…Acute pain after CTS has been determined as a main risk factor in the pathogenesis of numerous postoperative side effects such as respiratory failure [2,3] . Inadequately controlling the postoperative pain (POP) increase the risk of pulmonary complications due to the diaphragmatic dysfunction and incapability of patients to take large-volume breaths [4] .…”

“…In last decades, several pharmacological and nonpharmacological interventions have been developed to reduce acute POP including opioids, paravertebral and epidural infusion of local anesthetics, sedatives, nerve blockades, intrapleural analgesia, nerve stimulation, ketamine, gabapentinoids, selective COX-2 inhibitors, nonsteroidal anti-inflammatory drugs, alpha2- agonists, and aromatherapy [2,7] . However, the effectiveness and efficacy of those interventions are variable among studies.…”

“…However, the effectiveness and efficacy of those interventions are variable among studies. Many of those interventions, particularly opioids, have several side effects that can impair cardiac and respiratory function following surgery [1,2] . In addition, the benefits of thoracic epidural analgesia as a gold standard for controlling POP have been questioned because of higher risk of severe cardiovascular complications [8] .…”

Intercostal Neurolysis for The Treatment of Postsurgical Thoracic Pain: a Case Series

“…Neuropathic pain of PTPS may be resistant to medical, psychiatric, physical, or more invasive treatments such as nerve blocks, trigger point injections, and neuromodulation techniques . Trends and new evidence in the management of PTPS have been recently published, but intercostal surgical neurolysis has not been mentioned as a possible therapeutic option . Approaches such as continuous extrapleural infusion and epidural analgesia may cause severe adverse events, whereas surgical neurolysis is a more conservative approach, preserving the integrity of the nerve.…”

“…3 Trends and new evidence in the management of PTPS have been recently published, but intercostal surgical neurolysis has not been mentioned as a possible therapeutic option. 10 Approaches such as continuous extrapleural infusion and epidural analgesia may cause severe adverse events, 4 whereas surgical neurolysis is a more conservative approach, preserving the integrity of the nerve. Surgical nerve neurolysis involves a local intervention with a small incision and has potential clinical benefits in a short period.…”