Pain Management Strategies for Thoracotomy and Thoracic Pain Syndromes

Bottiger, Brandi A. MD
Esper, Stephen A. MD, MBA
Stafford-Smith, Mark MD

¹Duke University Medical Center, Durham, NC, USA
²University of Pittsburgh, Pittsburgh, PA, USA

Corresponding Author:

Mark Stafford-Smith, Duke University Medical Center, 2301 ErwinRoad, Box 3094 DUMC, Durham, NC 27710, USA.

Seminars in Cardiothoracic and Vascular Anesthesia 18(1):p 45-56, March 2014. | DOI: 10.1177/1089253213514484

Abstract

Pain after thoracic surgery can be severe and, in the acute phase, contribute to perioperative morbidity and mortality. Unfortunately, patients also incur a significant risk of chronic pain. Although there are guidelines for postoperative pain management in these patients, there is no widespread surgical or anesthetic “best practice.” Here, we review the recent literature on techniques specific to perioperative pain control for thoracic patients, including medical management, neuraxial blockade, and other regional techniques, and suggest an algorithm for developing a multimodal pain management strategy.