Postthoracotomy Pain Management Problems
Section snippets
Acute postthoracotomy pain
Severe acute pain after thoracotomy caused by retraction, resection, or fracture of ribs, dislocation of costovertebral joints, injury of intercostal nerves, and further irritation of the pleura by chest tubes is a normal response to all these insults [26]. Acute pain after video-assisted thoracoscopic surgery is considered less severe.
Suboptimal management of pain after thoracotomy (or after video-assisted thoracoscopic surgery in patients who have severely limited respiratory reserve) has
Chronic postthoracotomy pain
Postthoracotomy pain syndrome (chronic postthoracotomy pain or postthoracotomy neuralgia, PTPS) is defined by the International Association for the Study of Pain as “pain that recurs or persists along a thoracotomy incision at least two months following the surgical procedure.” In general, it is burning and stabbing pain with dysesthesia and thus shares many features of neuropathic pain [29]. PTPS is acknowledged increasingly by anesthesiologists and surgeons alike [30].
Prevalence of postthoracotomy pain
Chronic postthoracotomy pain was noted commonly by surgeons during the Second World War in men who had had a thoracotomy for chest trauma; it was called “chronic intercostal pain.” Unfortunately, not much has changed since then, because the majority of patients do not seek help for their pain but mention it only when specifically asked.
Furthermore, despite a commonly held belief that postthoracotomy pain is transient, there is no evidence that the pain experience decreases significantly over
Mechanism of postthoracotomy pain
There are several mechanisms for chronic pain after thoracotomy, and no consensus exists regarding causality.
Median or paramedian approach
Most practitioners prefer either the median or paramedian approach. There seems to be little difference in terms of patient safety. The paramedian approach makes it much easier to locate the epidural space when overlapping spinous processes might prevent the operator from reaching the epidural space in the median plane.
Asleep versus awake technique
The difference between an awake technique and an asleep technique should have a major impact on potential spinal cord cannulation. Surprisingly, a survey of the practice of
References (99)
- et al.
Comparison of thoracic and lumbar epidural infusions of bupivacaine and fentanyl for post-thoracotomy analgesia
J Cardiothorac Vasc Anesth
(1993) - et al.
Thoracic epidural analgesia with bupivacaine and fentanyl for postoperative thoracotomy pain
J Cardiothorac Vasc Anesth
(1994) - et al.
Paravertebral block with ropivacaine 0.5% versus systemic analgesia for pain relief after thoracotomy
Ann Thorac Surg
(2005) - et al.
Single-injection thoracic paravertebral block for postoperative pain treatment after thoracoscopic surgery
Br J Anaesth
(2005) - et al.
Intrathecal morphine during thoracotomy, part I: effect on intraoperative enflurane requirements
J Cardiothorac Vasc Anesth
(1993) Pro: every postthoracotomy patient deserves thoracic epidural analgesia
J Cardiothorac Vasc Anesth
(1999)- et al.
Comparison between repeat bolus intrathecal morphine and an epidurally delivered bupivacaine and fentanyl combination in the management of post-thoracotomy pain with or without cyclooxygenase inhibition
J Cardiothorac Vasc Anesth
(2002) - et al.
IV diclofenac in post-thoracotomy pain
Br J Anaesth
(1992) - et al.
Impact of acute pain and its management for thoracic surgical patients
Thorac Surg Clin
(2005) - et al.
Management of postthoracotomy pain: acute and chronic
Thorac Surg Clin
(2006)
Therapists and therapies for post-thoracotomy neuralgia
Pain
Postthoracotomy pain syndrome
Thorac Surg Clin
The morbidity, time course and predictive factors for persistent post-thoracotomy pain
Eur J Pain
Neurophysiologic assessment of nerve impairment in posterolateral and muscle-sparing thoracotomy
J Thorac Cardiovasc Surg
Pain and physical function are similar following axillary, muscle-sparing vs posterolateral thoracotomy
Chest
Double-blind comparison of intrapleural saline and 0.25% bupivacaine for ipsilateral shoulder pain after thoracotomy in patients receiving thoracic epidural analgesia
Br J Anaesth
Low-volume interscalene brachial plexus block for post-thoracotomy shoulder pain
J Cardiothorac Vasc Anesth
Thoracic epidural local anesthetics are ineffective in alleviating post-thoracotomy ipsilateral shoulder pain
J Cardiothorac Vasc Anesth
Acetaminophen decreases early post-thoracotomy ipsilateral shoulder pain in patients with thoracic epidural analgesia: a double-blind placebo-controlled study
J Cardiothorac Vasc Anesth
Efficacy of methods of intercostal nerve blockade for pain relief after thoracotomy
Ann Thorac Surg
Comparison of epidural analgesia and intercostal nerve cryoanalgesia for post-thoracotomy pain control
Eur J Pain
A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy—a systematic review and meta-analysis of randomized trials
Br J Anaesth
Variability of a thoracic paravertebral block. Are we ignoring the endothoracic fascia?
Reg Anesth Pain Med
Subcutaneous formalin-induced activity of dorsal horn neurones in the rat: differential response to an intrathecal opiate administered pre or post formalin
Pain
Phase 1A safety assessment of intravenous amitriptyline
J Pain
The value of pre-emptive analgesia in the treatment of postoperative pain
Br J Anaesth
Influence of timing on the effect of continuous extradural analgesia with bupivacaine and morphine after major abdominal surgery
Br J Anaesth
Chronic pain and thoracic surgery
Thorac Surg Clin
Effects of preemptive epidural analgesia on post-thoracotomy pain
J Cardiothorac Vasc Anesth
Pre-emptive effect of multimodal analgesia in thoracic surgery
Br J Anaesth
Multimodal analgesia before thoracic surgery does not reduce postoperative pain
Br J Anaesth
Cough dynamics in the post-thoracotomy state
Chest
Study design to demonstrate clinical value of preemptive analgesia: is the commonly used approach valid?
Reg Anesth Pain Med
Efficacy of ketorolac tromethamine and extrapleural intercostal nerve block on post-thoracotomy pain. A prospective, randomized study
Int Surg
Comparative study of continuous extrapleural intercostal nerve block and lumbar epidural morphine in post-thoracotomy pain
Can J Surg
A combined chest drain and intrapleural catheter for post-thoracotomy pain relief
Anaesthesia
Pain relief and respiratory mechanics during continuous intrapleural bupivacaine administration after thoracotomy
Thorac Cardiovasc Surg
Cryoanalgesia for post-thoracotomy pain relief
Acta Anaesthesiol Belg
The control of post-thoracotomy pain. A comparative evaluation of thoracic epidural fentanyl infusions and cryo-analgesia
Anaesthesia
A comparison of lumbar epidural and intravenous fentanyl infusions for post-thoracotomy analgesia
Can J Anaesth
Post-operative analgesia by high thoracic epidural versus intramuscular nicomorphine after thoracotomy. Part III. The effects of per- and post-operative analgesia on morbidity
Acta Anaesthesiol Scand
Continuous paravertebral extrapleural infusion for post-thoracotomy pain management
Surgery
Post-thoracotomy analgesia: epidural vs intravenous morphine continuous infusion
Minerva Anestesiol
Patient-controlled lumbar epidural fentanyl compared with patient-controlled intravenous fentanyl for post-thoracotomy pain
Can J Anaesth
Double-blind randomized evaluation of intercostal nerve blocks as an adjuvant to subarachnoid administered morphine for post-thoracotomy analgesia
Reg Anesth
The efficacy of intrathecal morphine in post-thoracotomy pain management
J Int Med Res
Caudal epidural morphine for post-thoracotomy pain
Anesth Analg
Transcutaneous nerve stimulation in post-thoracotomy pain relief
Anaesthesia
Transcutaneous electric nerve stimulation for the treatment of postthoracotomy pain: a randomized prospective study
Thorac Cardiovasc Surg
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