An unknown number of patients who undergo thoracic surgery develop post-thoracotomy neuralgia (PTN). Many seek a cure. As with other chronic, benign pain conditions, a variety of treatment modalities may be offered by different specialists. Results of therapy in terms of patient satisfaction are not known. A record of 73 patients with PTN was made. It has been used to measure the incidence, the natural and therapeutic history and the success of the management of PTN. Over 70% of the cases received three or more of the treatment modalities and regimens that have been reputed to be of value. More than 50% were referred to three different types of specialist. No patient claimed to have become free of symptoms as a result of treatment and a significant proportion, not clearly defined, implied that therapy was either more disabling than PTN or made it worse. Side effects of drugs were blamed for the former, and invasive treatments, aimed at nociceptive pathways, were incriminated in the latter. It is reasoned that about 5% of patients undergoing thoracic surgery may require resources for the management of PTN. No patient studied thought that conventional treatments had brought about a cure. Some treatments, known to be deleterious, remain extant. This information reflects and corroborates that from other studies which suggests that multidisciplinary approaches are more appropriate for chronic benign pain conditions than management by isolated physicians using specific therapies.

Fourteen patients had percutaneous cryotherapy for persistent post-thoracotomy neuralgia. Although a significant proportion had their condition improved, relief was temporary. However, a third felt that symptoms were exacerbated by the therapy.

Anesthesia for thoracoscopy is based on one lung ventilation. Lung separators in the airway are essential tools. An anatomical shunt as a result of the continued perfusion of a non-ventilated lung is the principal intraoperative concern. The combination of equipment, technique and process increase risks of hypoxia and dynamic hyperinflation, in turn, potential factors in the development of an unusual form of pulmonary edema. Analgesia management is modelled on that shown effective and therapeutic for thoracotomy. Perioperative management needs to reflect the concern for these complex, and complicating, processes to the morbidity of thoracoscopic surgery.

No abstract