| More

Post – operative analgesia in patients under thoracotomy

Views: 236 Downloads: 245
Evangelos Giavasopoulos
Evangelos Giavasopoulos


The thoracotomy is one of the most painful surgery operations, and the final outcome is directly associated with the postoperative pain control, because it allows quick mobilization, intense respiratory physiotherapy and reduces postoperative morbidity. Unfortunately, patients under thoracotomy, incur a significant risk of chronic pain. Although there are guidelines for the management of post-operative pain relief in these patients, however there is no widespread surgical or anesthetic "gold standard."  In the present article it has been investigated the current literature related to the proposed therapies and other interventions that were recommended for  post-operative pain relief  after thoracotomy. The treatment of chronic pain after thoracotomy is difficult and includes physical rehabilitation techniques and multimodal approach. More and more researchers support that minimization of acute post-operative pain is the best method so as to avoid, prevent or reduce post- thoracotomy pain syndrome.


Thoracotomy; acute post operative pain; post thoracotomy pain syndrome; multimodal analgesia; epidural analgesia; blockage nerves

Full Text:



Bottiger BA, Esper SA, Stafford-Smith M. Pain management strategies for thoracotomy and thoracic pain syndromes. Semin Cardiothorac Vasc Anesth 2014;18(1):45-56.

Merskey H, Bogduk N. Classification of chronic pain: description of chronic pain syndrom and definition of pain terms. Ed., IASP Press , Seattle (WA) 1994;p. 222.

Koehler RP, Keenan RJ. Management of postthoracotomy pain: acute and chronic. Thorac Surg Clin 2006; 16(3):287-297.

Kruger M, McRae K. Pain management in cardiothoracic practice. Surg Clin North Am 1999; 79(2): 387-400.

Ochroch EA, Gottschalk A. Impact of acute pain and its management for thoracic surgical patients. Thorac Surg Clin 2005; 15(1): 105-121.

Cerfolio RJ Bryant AS, Bass CS, Bartolucci AA. A prospective, double – blinded, randomized trial evaluating the use of preemptive analgesia of the skin before thoracotomy. Ann Thorac Surg 2003; 76(4): 1055-1058.

Moiniche S, Kehlet H, Dahl JB. A qualitative and quantitative systematic review for postoperative pain relief. Anesthesiology 2002; 96(3): 725-741.

Ong CK, Lirk P, Seymour RA, Jenkins BJ. The efficacy of preemptive analgesia for acute postoperative pain management: a meta-analysis. Anesth Analg 2005; 100(3) : 757-773.

Perttunen K, Nilsson E, Heinonen J, Hirvisalo EL, Salo JA, Kalso E. Extradural, Paravertebral and Intercostal nerve blocks for thoracotomy pain. Br J Anaesth 1995; 75(5): 541-547.

Kavanagh BP, Katz J, Sandler AN, Nierenberg H, Roger S, Boylan JF, Laws AK. Multimodal analgesia before thoracic surgery does not reduce postoperative pain. Br J Anaesth 1994; 73(2): 184-189.

Dahl JB, Rosenberg J, Dirkes WE, Mogensen T, Kehlet H. Prevention of postoperative pain by balanced analgesia. Br J Anaesth 1990; 64(4): 518-520.

Kehlet H, Dahl JB. The value of multimodal or balanced analgesia in postoperative pain treatment. Anesth Analg 1993; 77(5): 1048-1056.

Mοiniche S, Dahl JB, Rosenberg J, Kehlet H. Colonic resection with early discharge after combined subarachnoid epidural analgesia, preoperative glucocorticoids and early postoperative mobilization and feeding in a pulmonary high risk patient. Reg Anesth 1994; 19(5): 352-356.

Walder B, Schafer M, Henzi I, Tramèr MR. Efficacy and safety of patiemt-controled opioid analgesia for acute postoperative pain: a quantitative systematic review. Acta Anaesth Scand 2001; 45(7): 795-804.

Sidebotham D, Dijkhuizen MR, Schug SA. The safety and utilization of patient-controlled analgesia. J Pain Symptom Manage 1997; 14(4): 202-209.

Shulman M, Sandler AN, Bradley JW, Young PS, Brebner J. Post thoracotomy pain and pulmonary function following epidural and systemic morphine. Anesthesiology 1984; 61(5): 569-575.

Kavanagh BP, Katz J, Sandler AN. Pain control after thoracic surgery. A review of current techniques. Anesthesiology 1994; 81(3): 737-759.

Gilron I, Milne B, Hong M. Cyclooxygenase-2 inhibitors in postoperative pain management: current evidence and future directions. Anesthesiology 2003;99(5): 1198-1208.

Ilkjaer S, Petersen KL, Brennum J, Wernberg M, Dahl JB. Effect of systemic N-Methyl-D-Aspartate receptor antagonist (ketamine) on primary and secondary hyperalgesia in humans. Br J Anaesth 1996; 76(6): 829-834.

Suzuki M, Haraguti S, Sugimoto K, Kikutani T, Shimada Y, Sakamoto A. Low dose ketamine potentiates epidural analgesia after thoracotomy. Anesthesiology 2006; 105(1): 111-119.

Soto RG, Fu ES. Acute pain management for patients undergoing thoracotomy. Ann Thorac Surg 2003; 75(4): 1349-1357.

Oka T, Ozawa Y, Ohkubo Y. Thoracic epidural bupivacaine attenuates supraventricular tahyarrhythmias after pulmonary resection. Anesth Analg 2001; 93(2): 253-259.

Saada M, Catoire P, Bonnet F, Delaunay L, Gormezano G, Macquin-Mavier I, et al.Effect of thoracic epidural anesthesia combined with general anesthesia on segmental wall motion assessed by transesofageal echocardiography. Anesth Analg 1992; 75(3): 329-335.

Ready LB, Loper KA, Nessly M, Wild L. Postoperative epidural morphine is safe on surgical wards. Anesthesiology 1991; 75(3): 452-456.

Hansdóttir V, Woestenborghs R, Nordberg G. The pharmacokinetics of continuous epidural sufentanil and bupivacaine infusion after thoracotomy. Anesth Analg 1996; 83(2): 401-406.

Scott NB, Kehlet H. Regional anaesthesia and surgical morbidity. Br J Surg 1988; 75(4): 299-304.

Chan VW, Chung F, Cheng DC, Seyone C, Chung A, Kirby TJ. Analgesic and pulmonary effects of continuous intercostal nerves block following thoracotomy. Can J Anaesth 1991; 38(6): 733-739.

Moore D. Bridenbauch LD. Pneumothorax, it’s incidence following intercostals nerve block. Jama 1960; 15(174): 842-847.

Concha M, Dagnino J, Cariaga M, Aguilera J, Aparicio R, Guerrero M. Analgesia after thoracotomy: epidural fentanyl / bupivacaine compared with intercostals nerve block plus intravenous morphine. J Cardiovasc Anaesth 2004; 18(3): 322-326.

Ablondi MA, Ryan JF, O'Connell CT, Haley RW. Continuous intercostals nerve blocks for postoperative pain relief. Anesth Analg 1996; 45(2): 185-189.

Middaugh RE, Menk EJ, Reynolds WJ, Bauman JM, Cawthon MA, Hartshorne MF. Epidural block using large volumes of local anesthetic solution for intercostals nerve block. Anesthesiology 1985; 63(2): 214-216.

Ferrante FM, Chan VW, Arthur GR, Rocco AG. Interpleural analgesia after thoracotomy. Anesth Analg 1991; 72(1): 105-109.

Schneider RF, Villamena PC, Harvey J, Surick BG, Surick IW, Beattie EJ. Lack of efficacy of intrapleural bupivacaine for postoperative analgesia following thoracotomy. Chest 1993; 103(2): 414-416.

Joshi GP, Bonnet F, Shah R, Wilkinson RC, Camu F, Fischer B, et al.A systematic review of randomized trials evaluating regional techniques for posthoracotomy analgesia. Anesth Analg 2008; 107(3): 1026-1040.

Katz J, Jackson M, Kavanagh BP, Sandler AN. Acute pain after thoracic surgery predicts long term postthoracotomy pain. Clin J Pain 1996; 12(1): 50-55.

Sentürk M, Ozcan PE, Talu GK, Kiyan E, Camci E, Ozyalçin S, et al. The effect of three different analgesia techniques on long term postthoracotomy pain. Anesth Analg 2002; 94(1): 11-15.

Karmakar MK, Ho AM. Postthoracotomy pain syndrome. Thorac Surg Clin 2004; 14(3): 345-352.

Solak O, Metin M, Esme H, Solak O, Yaman M, Pekcolaklar A, et al. Effectiveness of gabapentin in the treatment of chronic post-thoracotomy pain. Eur J Cardiothorac Surg 2007; 32(1): 9-12.

Sihoe AD, Lee TW, Wan IY, Thung KH, Yim AP. The use of gabapentin for post operative and posttraumatic pain in thoracic surgery patients. Eur J Cardiothorac Surg 2006; 29(5): 795-799.

Davies AN, Rozanio CJ. Analgesia for Thoracic Surgery. Anaesthesia and Intensive Care Medicine, 2014; v15( 11):514-516.


  • There are currently no refbacks.

Health and Research Journal