title: Perioperative pain management after thoracotomy.
abstract: OBJECTIVE
  Perioperative acute pain and the development of persistent pain after thoracotomy are major problems severely affecting health-related quality of life. This review examines and highlights recent strategies and advances in perioperative pain management in this field.
  
  
  RESULTS
  Despite the fact that thoracic epidural analgesia (TEA) is considered the 'gold standard' of perioperative care after thoracotomy, other local and regional techniques have emerged within recent years and seem to become valid alternatives to TEA. The use of continuous paravertebral blockade, in particular, may provide similar analgesia and fewer adverse effects than TEA. Multimodal systemic approaches, including the use of ketamine and gabapentinoids are being investigated as well as the effect of surgical techniques and adjuvant therapies such as transcutaneous electrical nerve stimulation on post-thoracotomy pain.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, and Pharmacology and Anaesthesiology Unit, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
authors.forename: Manuel
authors.initials: M
authors.lastname: Wenk
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Schug
mesh_terms: D015360:Analgesia, Epidural; D006801:Humans; D009407:Nerve Block; D010149:Postoperative Pain / Q000628:therapy*; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods