The state of the art in preventing postthoracotomy pain.
Pain after thoracic surgery can be intense and prolonged. Inadequate pain management can have several detrimental effects, including increased postoperative morbidity and delayed recovery as well as occurrence of postthoracotomy syndrome. Therefore, establishing an adequate analgesic regimen for thoracic surgery is critical. Thoracic paravertebral block or thoracic epidural analgesia is recommended as the first-choice therapies for postthoracotomy analgesia. When these techniques are either contraindicated or not possible, intercostal analgesia or intrathecal opioids are recommended. These techniques should be combined with nonopioid analgesics, such as acetaminophen, nonsteroidal anti-inflammatory drugs, or cyclooxygenase-2-specific inhibitors, administered on a regular "round-the-clock" basis, with opioids used as "rescue" analgesics. Finally, the integration of multimodal analgesia techniques with multidisciplinary rehabilitation program can enhance recovery, reduce hospital stay, and facilitate early convalescence.
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas.
Alan
A
Romero
Jose Enrique L
JE
Garcia
Girish P
GP
Joshi
D000700:Analgesics / Q000627:therapeutic use*; D000765:Anesthesia, Conduction; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D006801:Humans; D007902:Length of Stay; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D020127:Recovery of Function; D013908:Thoracotomy / Q000009:adverse effects* / Q000534:rehabilitation; D013997:Time Factors; D016896:Treatment Outcome
D000700:Analgesics
COX-2 inhibitors; NSAIDs; opioids; postoperative pain; regional analgesia; thoracotomy