Perioperative pain management after thoracotomy

被引:49
作者
Wenk, Manuel [2 ]
Schug, Stephan A. [1 ,3 ]
机构
[1] Royal Perth Hosp, UWA Anaesthesia, Dept Anaesthesia & Pain Med, Perth, WA 6847, Australia
[2] Univ Hosp Muenster, Dept Anesthesiol & Intens Care, Munster, Germany
[3] Univ Western Australia, Sch Med & Pharmacol, Pharmacol & Anaesthesiol Unit, Perth, WA 6009, Australia
关键词
analgesia; epidural analgesia; pain; paravertebral block; thoracic surgery; thoracotomy; THORACIC EPIDURAL ANALGESIA; PROSPECTIVE RANDOMIZED-TRIAL; IPSILATERAL SHOULDER PAIN; INTERCOSTAL MUSCLE FLAP; POSTTHORACOTOMY PAIN; POSTOPERATIVE ANALGESIA; LUNG TRANSPLANTATION; PARAVERTEBRAL BLOCK; PULMONARY-FUNCTION; MAJOR THORACOTOMY;
D O I
10.1097/ACO.0b013e3283414175
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Purpose of review Perioperative acute pain and the development of persistent pain after thoracotomy are major problems severely affecting health-related quality of life. This review examines and highlights recent strategies and advances in perioperative pain management in this field. Recent findings Despite the fact that thoracic epidural analgesia (TEA) is considered the 'gold standard' of perioperative care after thoracotomy, other local and regional techniques have emerged within recent years and seem to become valid alternatives to TEA. The use of continuous paravertebral blockade, in particular, may provide similar analgesia and fewer adverse effects than TEA. Multimodal systemic approaches, including the use of ketamine and gabapentinoids are being investigated as well as the effect of surgical techniques and adjuvant therapies such as transcutaneous electrical nerve stimulation on post-thoracotomy pain. Summary Even though thoracotomy is associated with significant postoperative complications, a growing understanding of the underlying pathophysiology and advances in multimodal pain therapy concepts in this specific group of patients are promising improved postoperative outcomes and potential reduction of the incidence of persistent pain.
引用
收藏
页码:8 / 12
页数:5
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  • [1] Prospective, randomized, controlled trial of thoracic epidural or patient-controlled opiate analgesia on perioperative quality of life
    Ali, M.
    Winter, D. C.
    Hanly, A. M.
    O'Hagan, C.
    Keaveny, J.
    Broe, P.
    [J]. BRITISH JOURNAL OF ANAESTHESIA, 2010, 104 (03) : 292 - 297
  • [2] Intercostal Muscle Flap for Decreasing Pain After Thoracotomy: A Prospective Randomized Trial
    Allama, Amr Mohammad
    [J]. ANNALS OF THORACIC SURGERY, 2010, 89 (01) : 195 - 199
  • [3] A Randomized Controlled Trial of Bupivacaine Through Intracostal Catheters for Pain Management After Thoracotomy
    Allen, Mark S.
    Halgren, Lisa
    Nichols, Francis C., III
    Cassivi, Stephen D.
    Harmsen, William S.
    Wigle, Dennis A.
    Shen, K. Robert
    Deschamps, Claude
    [J]. ANNALS OF THORACIC SURGERY, 2009, 88 (03) : 903 - 910
  • [4] Effect of Preincisional Epidural Fentanyl and Bupivacaine on Postthoracotomy Pain and Pulmonary Function
    Amr, Yasser Mohamed
    Yousef, Ayman Abd Al-Maksoud
    Alzeftawy, Ashraf E.
    Messbah, Wail I.
    Saber, Ahmed Mohamed
    [J]. ANNALS OF THORACIC SURGERY, 2010, 89 (02) : 381 - 386
  • [5] Multimodal analgesia for controlling acute postoperative pain
    Buvanendran, Asokumar
    Kroin, Jeffrey S.
    [J]. CURRENT OPINION IN ANESTHESIOLOGY, 2009, 22 (05) : 588 - 593
  • [6] A nondivided intercostal muscle flap further reduces pain of thoracotomy: A prospective randomized trial
    Cerfolio, Robert James
    Bryant, Ayesha S.
    Maniscalco, Lee M.
    [J]. ANNALS OF THORACIC SURGERY, 2008, 85 (06) : 1901 - 1907
  • [7] Acupuncture to relieve the pain of thoracotomy: Commentary on randomized, controlled trial
    Chong, Lee-Yee
    Treasure, Tom
    [J]. JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2008, 136 (06) : 1470 - 1471
  • [8] Dabir Shideh, 2008, Asian Cardiovasc Thorac Ann, V16, P370
  • [9] Update on the role of paravertebral blocks for thoracic surgery: are they worth it?
    Daly, David J.
    Myles, Paul S.
    [J]. CURRENT OPINION IN ANESTHESIOLOGY, 2009, 22 (01) : 38 - 43
  • [10] Danelli G, 2007, EUR J ANAESTH, V24, P596, DOI 10.1017/S0265021506002390