Trends and New Evidence in the Management of Acute and Chronic Post-Thoracotomy Pain-An Overview of the Literature from 2005 to 2015.

Abstract

IN ADDITION TO being a major stressor, thoracotomies are associated with moderate-to-severe pain, impairment of respiratory function, protracted recovery, and the potential for the development of chronic pain. Of all surgical procedures, thoracotomies may create the greatest demand for postoperative analgesia. Even after less-invasive techniques, such as videoand robotic-assisted thoracoscopic surgery, postoperative pain is of considerable concern. Uncontrolled post-thoracotomy pain has important implications for a patient’s recovery and can add significant morbidity and increase healthcare costs. Absence of adequate post-thoracotomy analgesia in patients undergoing lung surgery may be associated with delayed postoperative extubation. Cywinski et al conducted a logistic regression analysis on 2,068 patients who underwent open thoracotomy for pneumonectomy, lobectomy, or segmental lung resection and found that the absence of thoracic epidural analgesia (TEA) was a significant predictor of delayed extubation. Based on the authors’ review of the relevant literature, in the past decade no single paradigm shift in the treatment of postthoracotomy pain has been reported. Cumulatively, however, a recent body of evidence now supports an expanded armamentarium of pharmacologic and procedural interventions and an improved understanding concerning the etiology of thoracotomy pain. The aim of this review was to report on many of these numerous incremental findings by providing a concise overview and discussion of recent relevant evidence, which, in aggregate, could contribute to improved clinical outcomes.