REVIEW ARTICLE


Pharmacological Management of Post-thoracotomy Pain



Joel Wann Ee Chin1, Kamen Valchanov2, *
1 Addenbrooke’s Hospital NHS Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
2 Papworth Hospital NHS Trust, Papworth Everard, Cambridge, CB23 3RE, United Kingdom


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© Ee Chin and Valchanov; Licensee Bentham Open

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (https://creativecommons.org/licenses/by-nc/4.0/legalcode), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Papworth Hospital NHS Trust, Papworth Everard, Cambridge, CB23 3RE, United Kingdom; Tel: +441480830541: E-mail: kamen.valchanov@nhs.net


Abstract

Thoracotomy is widely recognised as one of the most painful surgical procedures. The combination of extensive tissue dissection and dynamic respiratory movement postoperatively makes post-thoracotomy pain control particularly challenging. In the short term, inadequate analgesia is associated with respiratory complications, poor mobilisation, delayed discharge and respiratory infections. More importantly, poorly controlled postoperative pain is associated with developing chronic post-thoracotomy pain, also known as post-thoracotomy pain syndrome (PTPS). The reported incidence is between 25-60% and can be debilitating and difficult to treat. Increasing understanding of complex nociceptive pathways and neuropathic mechanisms has generated interest in the use of new therapeutic agents termed as adjuncts to post-operative opioid analgesia. In the area of thoracic surgery, the use of analgesic adjuncts has been subjected to a number of studies in recent years. In this article, we present a literature review of current treatment strategies for management of post-thoracotomy pain with evidence of effectiveness.

Keywords: Analgesic adjuncts, Chronic pain, Multimodal analgesia, Post-thoracotomy pain.