Pain Management Strategies for Thoracotomy and Thoracic Pain Syndromes

Bottiger, Brandi; Esper, Stephen A.; Stafford‐Smith, Mark

doi:10.1177/1089253213514484

Cited by 57 publications

(36 citation statements)

References 92 publications

(98 reference statements)

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“…This complex is also known as postthoracotomy pain syndrome (PTPS) (17). The reported incidence is quite high, ranging from 30% to 80% by varied studies but without difference between VATS and thoracotomy (3,18). In this study we questionnaire the patients by telephone three months after procedure and found that parecoxib significantly reduced the incision related pain.…”

Section: Discussionmentioning

confidence: 64%

Effect of parecoxib combined with thoracic epidural analgesia on pain after thoracotomy

Ling¹,

Fang²,

Zhang³

et al. 2016

J. Thorac. Dis.

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Background: Thoracotomy results in severe postoperative pain potentially leading to chronic pain. We investigated the potential benefits of intravenous parecoxib on postoperative analgesia combined with thoracic epidural analgesia (TEA).Methods: Eighty-six patients undergoing thoracic surgery were randomized into two groups. Patientcontrolled epidural analgesia (PCEA) was used until chest tubes were removed. Patients received parecoxib (group P) or placebo (group C) intravenously just 0.5 h before the operation and every 12 h after operation for 3 days. The intensity of pain was measured by using a visual analogue scale (VAS) and recorded at 2, 4, 8, 24, 48, 72 h after operation. The valid number of PCA, the side effects and the overall satisfaction to analgesic therapy in 72 h were recorded. Venous blood samples were taken before operation, the 1 st and 3 rd day after operation for plasma cortisol, adrenocorticotropic hormone (ACTH), interleukin-6 and tumor necrosis factor-α level. The occurrence of residual pain was recorded using telephone questionnaire 2 and 12 months after surgery.Results: Postoperative pain scores at rest and on coughing were significantly lower with the less valid count of PCA and greater patient satisfaction in group P (P<0.01). Adverse effect and the days fit for discharge were comparable between two groups. The cortisol levels in placebo group were higher than parecoxib group at T2. The level of ACTH both decreased in two groups after operation but it was significantly lower in group P than that in group C. There were no changes in plasma IL-6 and TNF-α levels before and after analgesia at T 1 and T 2 (P>0.05). The occurrence of residual pain were 25% and 51.2% separately in group P and C 3 months postoperatively (P<0.05).Conclusions: Intravenous parecoxib in multimodal analgesia improves postoperative analgesia provided by TEA, relieves stress response after thoracotomy, and may restrain the development of chronic pain.

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Section: Discussionmentioning

confidence: 64%

Effect of parecoxib combined with thoracic epidural analgesia on pain after thoracotomy

Ling¹,

Fang²,

Zhang³

et al. 2016

J. Thorac. Dis.

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“…Several strategies have been introduced for POP management [35] . It is believed that multimodal analgesic approaches combining different analgesic agents with different mechanisms of action can maximize pain relief while minimize the opioid consumption and thus can limit the opioid-induced side effects [6,36] .…”

Section: Discussionmentioning

confidence: 99%

“…It is believed that multimodal analgesic approaches combining different analgesic agents with different mechanisms of action can maximize pain relief while minimize the opioid consumption and thus can limit the opioid-induced side effects [6,36] . As a method of limiting opioid-induced adverse events, therefore, multimodal POP management has the potential to decrease morbidity and mortality after surgery [35] . Consequently, it is expected that the sedative, anesthetic, analgesic, and cardiorespiratory effects of DEX may enhance with concomitant administration with other anesthetic, sedative and analgesic medications [28] .…”

Section: Discussionmentioning

confidence: 99%

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

Hassani¹,

Kiabi²,

Sharifi³

2018

Braz J Cardiovasc Surg

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IntroductionAcute post-operative pain remains a troublesome complication of cardiothoracic surgeries. Several randomized controlled trials have examined the efficacy of dexmedetomidine as a single or as an adjuvant agent before, during and after surgery. However, no evidence-based conclusion has been reached regarding the advantages of dexmedetomidine over the other analgesics.ObjectiveTo review the effect of dexmedetomidine on acute post-thoracotomy/sternotomy pain.MethodsMedline, SCOPUS, Web of Science, and Cochrane databases were used to search for randomized controlled trials that investigated the analgesia effect of dexmedetomidine on post-thoracotomy/sternotomy pain in adults' patients. The outcomes were postoperative pain intensity or incidence, postoperative analgesia duration, and the number of postoperative analgesic requirements.ResultsFrom 1789 citations, 12 trials including 804 subjects met the inclusion criteria. Most studies showed that pain score was significantly lower in the dexmedetomidine group up to 24 hours after surgery. Two studies reported the significant lower postoperative analgesia requirements and one study reported the significant lower incidence of acute pain after surgery in dexmedetomidine group. Ten studies found that the total consumption of narcotics was significantly lower in the dexmedetomidine group. The most reported complications of dexmedetomidine were nausea/vomiting, bradycardia and hypotension.ConclusionDexmedetomidine can be used as a safe and efficient analgesic agent for reducing the postoperative pain and analgesic requirements up to 24 hours after cardiothoracic surgeries. However, further well-designed trials are needed to find the optimal dosage, route, time, and duration of dexmedetomidine administration.

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“…Unfortunately, no single drug or drug combination is completely effective in all patients . Moreover, side effects are common with prolonged use of these drugs, and tolerance can develop after opioid use . Preemptive analgesia was also not effective in reducing chronic postthoracotomy pain …”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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Pain Management Strategies for Thoracotomy and Thoracic Pain Syndromes

Cited by 57 publications

References 92 publications

Effect of parecoxib combined with thoracic epidural analgesia on pain after thoracotomy

Effect of parecoxib combined with thoracic epidural analgesia on pain after thoracotomy

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

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

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