Pain Relief After Thoracotomy

Conacher, I.D.

doi:10.1093/bja/65.6.806

Cited by 102 publications

(44 citation statements)

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“…These nerves may be injured during surgical incision, rib retraction, trocar placement, or suturing. 5,6 Post-thoracotomy pain syndrome is typically described as aching or tenderness and is localized to the area of incision in approximately 82% of cases. 7 Chronic postthoracotomy pain remains a challenge for clinicians, as many treatment and prevention strategies have yielded disappointing results.…”

Section: The International Association For the Study Of Pain Defines mentioning

confidence: 99%

Preventing Post‐Thoracotomy Pain Syndrome

Khelemsky

Noto

2012

Mount Sinai J Medicine

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This article provides a concise overview of post‐thoracotomy pain syndrome, describes anesthetic and surgical factors that have been investigated to reduce the incidence of the syndrome, and explores the effectiveness of various treatments for this condition. Although some interventions (both procedural and pharmacologic) have been investigated in both preventing and treating post‐thoracotomy pain syndrome, definitive studies are lacking and firm conclusions regarding the benefit of any intervention cannot be drawn. The problem is compounded further by our lack of understanding of the pathophysiologic mechanisms underlying the development of chronic pain after surgery. Going forward, it will be important to elucidate these mechanisms and conduct well‐designed trials involving novel therapeutic agents for both prevention and treatment of post‐thoracotomy pain syndrome. Mt Sinai J Med 79:133–139, 2012. © 2012 Mount Sinai School of Medicine

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Section: The International Association For the Study Of Pain Defines mentioning

confidence: 99%

Preventing Post‐Thoracotomy Pain Syndrome

Khelemsky

Noto

2012

Mount Sinai J Medicine

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“…Pain management based on an opioid-based protocol runs the risk of adverse drug events related to narcotics. Several recent reports have demonstrated that respiratory depression and deep levels of sedation can occur when morphine patientcontrolled analgesia (PCA) is prescribed (1)(2)(3)(4)(5)(6)(7). Th e patient with compromised pulmonary function may be at an increased risk for an adverse event.…”

mentioning

confidence: 99%

Dexmedetomidine Infusion for Analgesia Up to 48 Hours After Lung Surgery Performed by Lateral Thoracotomy

Ramsay

Newman

Leeper

et al. 2014

Baylor University Medical Center Proceedings

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“…3 Clinical symptoms of chronic postthoracotomy pain include allodynia, hyperalgesia, hypoesthesia (numbness at the injured site), and unprovoked burning pain. 4,5 These characteristics are similar to those of neuropathic pain induced by damage to large nerves or the spinal cord, suggesting intercostal nerve damage as the primary cause of postthoracotomy pain. However, no report has established a relationship between a specific damaged tissue and postthoracotomy pain.…”

Section: Discussionmentioning

confidence: 71%

A rat model of postthoracotomy pain: behavioural and spinal cord NK-1 receptor assessment

Nara

Saito

Obata

et al. 2001

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To develop a new rat model of postthoracotomy pain for investigating its mechanisms and clarifying neurochemical changes.M Me et th ho od ds s: : Male Wistar rats were randomly assigned to three groups that underwent either fourth and fifth intercostal nerve ligation, cutting of the fourth and fifth ribs, or a sham operation in which only pleura was cut. For behavioural response assessment during the following month, pinch and touch were used as mechanical stimuli, and acetone was used as a cold thermal stimulus. In addition, 125 I-substance P autoradiography was used to determine neurokinin (NK) receptor density in spinal cord laminae I and II at one to six weeks after surgery.R Re es su ul lt ts s: : In rats with nerve ligation, hypersensitivity to noxious and non-noxious stimuli continued throughout the month. The mirror phenomenon was observed. The lowest threshold was obtained in the dorsomedial portion of the T4 dermatome on the side of surgery. In rats with rib cutting, a lowered threshold to noxious and non-noxious stimuli was observed for two weeks. In rats with sham operations, hypersensitivity was seen only at postoperative day one. NK-1 receptor density on the side of operation increased significantly in rats with nerve ligation from day seven to 28. Receptor density was highest on day 14 (22.97 ± 1.04 fmol·mg 1 tissue vs control, 16.22 ± 0.43), representing a 50% receptor excess on the side of ligation compared to the contralateral side.C Co on nc cl lu us si io on n: : Intercostal nerve damage induces long-term postthoracotomy pain and an increase of spinal NK-1 receptors in rats. This model may be useful for investigation of postthoracotomy pain.Objectif : Élaborer un modèle de douleur post-thoracotomie chez le rat afin den explorer les mécanismes et den préciser les changements neurochimiques.Méthode : Des rats mâles Wistar ont été répartis au hasard en trois groupes et on subi une ligature des quatrième et cinquième nerfs intercostaux, ou la section des quatrième et cinquième côtes ou une opération fictive comportant une incision de la plèvre seulement.Pendant le mois suivant, on a évalué la réponse comportementale à des stimuli mécaniques, pincement et toucher, et la sensibilité au froid avec de lacétone. De plus, une autoradiographie de la substance P réalisée avec 125 I a été utilisée pour déterminer la densité du récep-teur de neurokinine (NK) dans les lames I et II de moelle épinière de une à six semaines après lopération. Résultats :Chez les rats avec ligature des nerfs, lhypersensibilité à des stimuli nocifs ou non sest poursuivie tout au long du mois. Le «phénomène miroir» a été observé. Le seuil le plus bas a été noté dans la portion dorsomédiane du dermatome T4 du côté de la ligature. Chez les rats aux côtes sectionnées, le seuil le plus bas aux stimuli nocifs ou non a été observé pendant deux semaines. Chez les rats qui ont subi une opération fictive, lhypersensibilité na été observée que le jour suivant lintervention. La densité du récepteur NK-1 du côté de l...

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Pain Relief After Thoracotomy

Cited by 102 publications

References 0 publications

Preventing Post‐Thoracotomy Pain Syndrome

Preventing Post‐Thoracotomy Pain Syndrome

Dexmedetomidine Infusion for Analgesia Up to 48 Hours After Lung Surgery Performed by Lateral Thoracotomy

A rat model of postthoracotomy pain: behavioural and spinal cord NK-1 receptor assessment

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