Treatment Of Post-thoracotomy Pain Research Articles

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

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.

The Pharmacology of New Drugs and New Uses for Older Drugs Used for Thoracic Pain Relief

Thoracotomy results in severe pain and deleterious changes in pulmonary physiology. These alterations are inevitable and can be minimized by effective analgesia. There are many options available for the treatment of postthoracotomy pain. Systemic opioids have been extensively used in this context but their side effects have led to the development of various routes of administration; the epidural route in combination with local anesthetics is the most effective. Other techniques include intercostal nerve block and intrapleural analge sia. Drugs such as clonidine, nonsteroidal anti-inflamma tory drugs, and ketamine are promising for the relief of pain after thoracotomy but further investigations are still warranted.

Central nervous system toxicity in a patient receiving continuous intrapleural bupivacaine

A patient developed signs of central nervous system (CNS) toxicity during treatment of postthoracotomy pain with a continuous intrapleural bupivacaine infusion. This incident occurred after the patient's chest tube was clamped, without any decrease in the bupivacaine infusion rate. This is the first reported case of CNS toxicity in a patient receiving a continuous intrapleural bupivacaine infusion. Possible etiologies of this complication are discussed, as are ways to avoid such a complication in the future.