Post-Thoracotomy Pain: Current Strategies for Prevention and Treatment

Gupta, Ruchir; Ven, Thomas Van de; Pyati, Srinivas

doi:10.1007/s40265-020-01390-0

Cited by 37 publications

(35 citation statements)

References 61 publications

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“…Acceleration of postoperative recovery (ERAS) protocols, which have become an important issue in thoracic surgery in recent years, especially support opioidfree and low complication rate analgesia protocols (23,24). The purpose of ERAS protocols is to reduce the complication rate by making the least intervention with the least complication and to ensure that the patients are discharged quickly and without problems (25,26).…”

Section: Discussionmentioning

confidence: 99%

Comparison of thoracic epidural analgesia and thoracic paravertebral block in pain management after thoracotomy

Zengin

Baldemir

Ulger

et al. 2022

Anatolian Current Medical Journal

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Aim: Thoracotomy is among the most painful surgical incisions and causes severe acute pain in the postoperative period. Many analgesic methods have been suggested for thoracotomy pain treatment. Thoracic epidural analgesia (TEA) and thoracic paravertebral block (TPVB) are common regional methods for post-thoracotomy pain. In this study, we aimed to compare the efficacy and the side effects of TEA and TPVB methods applied for post-thoracotomy analgesia. Material and Method:After ethical committee approval, we retrospectively analyzed postoperative analgesia records of patients, who underwent thoracotomy, received TEA or TPVB for postoperative analgesia between 01.01.2019 and 01.01.2021. Visual analog scale (VAS) scores of the patients who received analgesic treatment for 24 hours postoperatively after TEA or TPVB application were evaluated.Results: Data of 474 patients were found eligible for analysis. Demographic data of patients, VAS scores, patient satisfaction, and additional analgesic requirements were not statistically significant between the groups (p>0.05). Nausea-vomiting, hypotension, headache, itching, and sweating was statistically significantly higher in the TEA group when compared to patients who underwent TPVB (p<0.05). Conclusion:In the present study, in the early postoperative pain management after thoracotomy; it was observed that preemptive TPVB and postoperative IV patient-controlled analgesia (PCA) and TEA provided similar VAS scores and additional analgesic requirements. On the other hand, postoperative complications were observed less frequently in patients who underwent TPVB with postoperative IV PCA compared to TEA. Therefore, TPVB may be a good alternative to prevent acute pain after thoracotomy.

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Section: Discussionmentioning

confidence: 99%

Comparison of thoracic epidural analgesia and thoracic paravertebral block in pain management after thoracotomy

Zengin

Baldemir

Ulger

et al. 2022

Anatolian Current Medical Journal

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“…Acute postoperative pain following thoracotomy is mostly related with retraction, resection or fracture of the ribs, dislocation of costovertebral joints, injury of intercostal nerves and irritation of the pleura by the thoracic drains. Thoracotomy is also associated with pulmonary complications and with chronic or persistent post‐surgical pain 90,91,92,93 . In humans undergoing thoracotomy, a multimodal analgesic approach is recommended and usually combines systemic analgesic administration and locoregional techniques.…”

Section: Discussionmentioning

confidence: 99%

“…Thoracotomy is also associated with pulmonary complications and with chronic or persistent post-surgical pain. 90,91,92,93 In humans undergoing thoracotomy, a multimodal analgesic approach is recommended and usually combines systemic analgesic administration and locoregional techniques. The use of locoregional techniques aims to provide haemodynamic stability and postoperative pain control.…”

Section: Discussionmentioning

confidence: 99%

Alternative anaesthetic management in a reintervention for correction of a left‐to‐right shunting patent ductus arteriosus (PDA) in a dog

Medina‐Serra

Palacios

McMillan

2021

Vet Record Case Reports

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A three‐year‐old, male neutered, 2.7 kg Chihuahua was referred for correction of a type IIA, left‐to‐right shunting PDA. The correction of the PDA required two separate interventions. During the first intervention, a minimally invasive transvascular correction of the PDA that was converted to a thoracotomy was suspended after the evidence of iatrogenic haemopericardium. The second intervention, scheduled after the resolution of the haemopericardium, consisted of surgical ligation of the PDA via thoracotomy. Long periods of hypotension (mean arterial pressure below 60 mm Hg) were observed during the first intervention, during which anaesthesia was maintained with a combination of sevoflurane and infusions of fentanyl and lidocaine. The use of total intravenous anaesthesia with alfaxalone in conjunction with locoregional techniques in the second intervention provided smooth anaesthesia with improved cardiovascular stability.

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“…Post-thoracotomy pain syndrome (PTPS) occurs with a prevalence ranging from 25 to 57%, although severe in < 10% [ 23 ]. Post-thoracotomy pain is predominantly neuropathic in nature, and as with PPPBCS, the etiology is usually attributed to surgical nerve damage, being less common after minimally invasive surgery (e.g.…”

Section: Common Cancer Treatment-related Pain Syndromesmentioning

confidence: 99%

“…videoscopic-assisted surgery) than open thoracotomy. Unlike PPPBCS, preoperative risk stratification of susceptible individuals for PTPS is not well established [ 23 ]. Adjuvant radiation and chemotherapy appear to predispose patients to developing chronic PTPS.…”

Section: Common Cancer Treatment-related Pain Syndromesmentioning

confidence: 99%

Pharmacologic Management of Persistent Pain in Cancer Survivors

Glare

Aubrey

Gulati

et al. 2022

Drugs

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Improvements in screening, diagnosis and treatment of cancer has seen cancer mortality substantially diminish in the past three decades. It is estimated there are almost 20 million cancer survivors in the USA alone, but some 40% live with chronic pain after completing treatment. While a broad definition of survivorship that includes all people living with, through and beyond a cancer diagnosis-including those with active cancer-is often used, this narrative review primarily focuses on the management of pain in people who are disease-free after completing primary cancer treatment as adults. Chronic pain in this population needs a different approach to that used for people with a limited prognosis. After describing the common chronic pain syndromes caused by cancer treatment, and the pathophysiologic mechanisms involved, the pharmacologic management of entities such as post-surgical pain, chemotherapy-induced neuropathy, aromatase inhibitor musculoskeletal syndrome and checkpoint inhibitor-related pain are described. The challenges associated with opioid prescribing in this population are given special attention. Expert guidelines on pain management in cancer survivors now recommend a combination of pharmacologic and non-pharmacologic modalities, and these are also briefly covered.

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Post-Thoracotomy Pain: Current Strategies for Prevention and Treatment

Cited by 37 publications

References 61 publications

Comparison of thoracic epidural analgesia and thoracic paravertebral block in pain management after thoracotomy

Comparison of thoracic epidural analgesia and thoracic paravertebral block in pain management after thoracotomy

Alternative anaesthetic management in a reintervention for correction of a left‐to‐right shunting patent ductus arteriosus (PDA) in a dog

Pharmacologic Management of Persistent Pain in Cancer Survivors

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