Pain Management in Thoracic Surgery

  • Manish Kohli
  • Pradeep Jain


Pulmonary dysfunction of variable intensity occurs in post-thoracotomy patients. The severity of dysfunction depends not only on the sequelae or complex etiopathogenesis of the disease process for which thoracic surgery was done but also on the severity of pain which the patient experiences after thoracic surgery. In such scenarios, pain is the only factor that is manageable. Post-thoracotomy pain when left untreated, is associated with exaggerated pulmonary as well as extra pulmonary complications. This affects the quality of life and satisfaction levels of the patients, thereby resulting in longer hospital stay which in turn incurs increased costs [1]. Acute post-thoracotomy pain, when left unattended, may lead to an even worse situation: chronic post-thoracotomy pain (CPTP) [2, 3]. This type of pain is neuropathic in nature and is generally less detrimental to respiration, but it can be severely incapacitating, making daily activities impossible.


  1. 1.
    Stadler M, Schlander M, Braeckman M, et al. A cost-utility and cost-effectiveness analysis of an acute pain service. J Clin Anesth. 2004;16(3):159–67.Google Scholar
  2. 2.
    Maguire MF, Ravenscroft A, Beggs D, et al. A questionnaire study investigating the prevalence of the neuropathic component of chronic pain after thoracic surgery. Eur J Cardiothorac Surg. 2006;29(5):800–5.Google Scholar
  3. 3.
    Steegers MAH, Snik DM, Verhagen AF, et al. Only half of the chronic pain after thoracic surgery shows a neuropathic component. J Pain. 2008;9(10):955–61.Google Scholar
  4. 4.
    Nosotti M, Baisi A, Mendogni P, et al. Muscle sparing versus posterolateral thoracotomy for pulmonary lobectomy: randomised controlled trial. Interact Cardiovasc Thorac Surg. 2010;11(4):415–9.Google Scholar
  5. 5.
    Landreneau RJ, Mack MJ, Hazelrigg SR, et al. Prevalence of chronic pain after pulmonary resection by thoracotomy or video-assisted thoracic surgery. J Thorac Cardiovasc Surg. 1994;107(4):1079–85; discussion 85–6.Google Scholar
  6. 6.
    Holte K, Kehlet H. Effect of postoperative epidural analgesia on surgical outcome. Minerva Anestesiol. 2002;68(4):157–61.PubMedGoogle Scholar
  7. 7.
    Kehlet H. Effect of pain relief on the surgical stress response. Reg Anesth. 1996;21(6 Suppl):35–7.PubMedGoogle Scholar
  8. 8.
    Sorkin LS, Wallace MS. Acute pain mechanisms. Surg Clin North Am. 1999;79(2):213–29.PubMedGoogle Scholar
  9. 9.
    Liu S, Carpenter RL, Neal JM. Epidural anesthesia and analgesia. Their role in postoperative outcome. Anesthesiology. 1995;82(6):1474–506.PubMedGoogle Scholar
  10. 10.
    Macintosh RR, Mushin WW. Anaesthetics research in wartime. Med Times. 1945:253–5.Google Scholar
  11. 11.
    Mark JB, Brodsky JB. Ipsilateral shoulder pain following thoracic operations. Anesthesiology. 1993;79(1):192.PubMedGoogle Scholar
  12. 12.
    Pennefather SH, Russell GN. Postthoracotomy analgesia. In: Slinger PD, editor. Progress in thoracic anesthesia a society of cardiovascular anesthesiologists monograph. Philadelphia: Lippincott Williams and Wilkins; 2004.Google Scholar
  13. 13.
    Kol E, Alpar SE, Erdogan A. Preoperative education and use of analgesic before onset of pain routinely for post-thoracotomy pain control can reduce pain effect and total amount of analgesics administered postoperatively. Pain Manag Nurs. 2014;15(1):331–9.PubMedGoogle Scholar
  14. 14.
    Doan LV, Augustus J, Androphy R, et al. Mitigating the impact of acute and chronic post-thoracotomy pain. J Cardiothorac Vasc Anesth. 2014;28(4):1048–56.Google Scholar
  15. 15.
    Scarci M, Solli P, Bedetti B. Enhanced recovery pathway for thoracic surgery in the UK. J Thorac Dis. 2016;8(Suppl 1):S78–83.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Twycross RG. Choice of strong analgesic in terminal cancer: diamorphine or morphine? Pain. 1977;3(2):93–104.PubMedGoogle Scholar
  17. 17.
    Gulur P, Williams L, Chaudhary S, et al. Opioid tolerance—a predictor of increased length of stay and higher readmission rates. Pain Physician. 2014;17(4):E503–7.Google Scholar
  18. 18.
    Crile GW. The kinetic theory of shock and its prevention through anoci-association (shockless operation). Lancet. 1913;182(4688):7–16.Google Scholar
  19. 19.
    Bong CL, Samuel M, Ng JM, et al. Effects of preemptive epidural analgesia on post-thoracotomy pain. J Cardiothorac Vasc Anesth. 2005;19(6):786–93.Google Scholar
  20. 20.
    Hurley RW, Adams MC. Sex, gender, and pain: an overview of a complex field. Anesth Analg. 2008;107(1):309–17.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Perry F, Parker RK, White PF, et al. Role of psychological factors in postoperative pain control and recovery with patient-controlled analgesia. Clin J Pain. 1994;10(1):57–63; discussion 82–5.Google Scholar
  22. 22.
    Yokoyama M, Hanazaki M, Fujii H, et al. Correlation between the distribution of contrast medium and the extent of blockade during epidural anesthesia. Anesthesiology. 2004;100(6):1504–10.Google Scholar
  23. 23.
    Hirabayashi Y, Shimizu R. Effect of age on extradural dose requirement in thoracic extradural anaesthesia. Br J Anaesth. 1993;71(3):445–6.PubMedGoogle Scholar
  24. 24.
    Ip HY, Abrishami A, Peng PW, et al. Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology. 2009;111(3):657–77.Google Scholar
  25. 25.
    Bachiocco V, Morselli-Labate AM, Rusticali AG, et al. Intensity, latency and duration of post-thoracotomy pain: relationship to personality traits. Funct Neurol. 1990;5(4):321–32.Google Scholar
  26. 26.
    Caumo W, Schmidt AP, Schneider CN, et al. Preoperative predictors of moderate to intense acute postoperative pain in patients undergoing abdominal surgery. Acta Anaesthesiol Scand. 2002;46(10):1265–71.Google Scholar
  27. 27.
    Racine M, Sanchez-Rodriguez E, Galan S, et al. Factors associated with suicidal ideation in patient with chronic non-cancer pain. Pain Med. 2017;18:283–93.Google Scholar
  28. 28.
    Landreneau RJ, Hazelrigg SR, Mack MJ, et al. Postoperative pain-related morbidity: video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg. 1993;56(6):1285–9.Google Scholar
  29. 29.
    Iwasaki A, Hamatake D, Shirakusa T. Biosorbable poly-L-lactide rib-connecting pins may reduce acute pain after thoracotomy. Thorac Cardiovasc Surg. 2004;52(1):49–53.PubMedGoogle Scholar
  30. 30.
    Benedetti F, Vighetti S, Ricco C, et al. Neurophysiologic assessment of nerve impairment in posterolateral and muscle-sparing thoracotomy. J Thorac Cardiovasc Surg. 1998;115(4):841–7.Google Scholar
  31. 31.
    Ochroch EA, Gottschalk A, Augoustides JG, et al. Pain and physical function are similar following axillary, muscle-sparing vs posterolateral thoracotomy. Chest. 2005;128(4):2664–70.Google Scholar
  32. 32.
    Macchiarini P, Ladurie FL, Cerrina J, et al. Clamshell or sternotomy for double lung or heart-lung transplantation? Eur J Cardiothorac Surg. 1999;15(3):333–9.Google Scholar
  33. 33.
    Romsing J, Moiniche S, Ostergaard D, et al. Local infiltration with NSAIDs for postoperative analgesia: evidence for a peripheral analgesic action. Acta Anaesthesiol Scand. 2000;44(6):672–83.Google Scholar
  34. 34.
    Goppelt-Struebe M. Regulation of prostaglandin endoperoxide synthase (cyclooxygenase) isozyme expression. Prostaglandins Leukot Essent Fatty Acids. 1995;52(4):213–22.PubMedGoogle Scholar
  35. 35.
    Graham DJ, Campen D, Hui R, et al. Risk of acute myocardial infarction and sudden cardiac death in patients treated with cyclo-oxygenase 2 selective and non-selective non-steroidal anti-inflammatory drugs: nested case-control study. Lancet. 2005;365(9458):475–81.Google Scholar
  36. 36.
    Hippisley-Cox J, Coupland C. Risk of myocardial infarction in patients taking cyclo-oxygenase-2 inhibitors or conventional non-steroidal anti-inflammatory drugs: population based nested case-control analysis. BMJ. 2005;330(7504):1366.PubMedPubMedCentralGoogle Scholar
  37. 37.
    Glassman SD, Rose SM, Dimar JR, et al. The effect of postoperative nonsteroidal anti-inflammatory drug administration on spinal fusion. Spine (Phila Pa 1976). 1998;23(7):834–8.Google Scholar
  38. 38.
    Ling XM, Fang F, Zhang XG, et al. Effect of parecoxib combined with thoracic epidural analgesia on pain after thoracotomy. J Thorac Dis. 2016;8(5):880–7.Google Scholar
  39. 39.
    Dahl V, Raeder JC. Non-opioid postoperative analgesia. Acta Anaesthesiol Scand. 2000;44(10):1191–203.PubMedGoogle Scholar
  40. 40.
    McNicol ED, Ferguson MC, Haroutounian S, et al. Single dose intravenous paracetamol or intravenous propacetamol for postoperative pain. Cochrane Database Syst Rev. 2016;5:CD007126.Google Scholar
  41. 41.
    Remy C, Marret E, Bonnet F. Effects of acetaminophen on morphine side-effects and consumption after major surgery: meta-analysis of randomized controlled trials. Br J Anaesth. 2005;94(4):505–13.PubMedGoogle Scholar
  42. 42.
    Mathews TJ, Churchhouse AM, Housden T, et al. Does adding ketamine to morphine patient-controlled analgesia safely improve post-thoracotomy pain? Interact Cardiovasc Thorac Surg. 2012;14(2):194–9.Google Scholar
  43. 43.
    Mao J, Price DD, Mayer DJ. Mechanisms of hyperalgesia and morphine tolerance: a current view of their possible interactions. Pain. 1995;62(3):259–74.PubMedGoogle Scholar
  44. 44.
    Michelet P, Guervilly C, Helaine A, et al. Adding ketamine to morphine for patient-controlled analgesia after thoracic surgery: influence on morphine consumption, respiratory function, and nocturnal desaturation. Br J Anaesth. 2007;99(3):396–403.Google Scholar
  45. 45.
    Moyse DW, Kaye AD, Diaz JH, et al. Perioperative ketamine administration for thoracotomy pain. Pain Physician. 2017;20(3):173–84.Google Scholar
  46. 46.
    Menigaux C, Adam F, Guignard B, et al. Preoperative gabapentin decreases anxiety and improves early functional recovery from knee surgery. Anesth Analg. 2005;100(5):1394–9.Google Scholar
  47. 47.
    Serpell MG, Neuropathic Pain Study Group. Gabapentin in neuropathic pain syndromes: a randomised, double-blind, placebo-controlled trial. Pain. 2002;99(3):557–66.PubMedGoogle Scholar
  48. 48.
    Chang CY, Challa CK, Shah J, et al. Gabapentin in acute postoperative pain management. Biomed Res Int. 2014;2014:631756.Google Scholar
  49. 49.
    Zakkar M, Frazer S, Hunt I. Is there a role for gabapentin in preventing or treating pain following thoracic surgery? Interact Cardiovasc Thorac Surg. 2013;17(4):716–9.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Omran AF, Mohamed AER. A randomized study of the effects of gabapentin versus placebo on post-thoracotomy pain and pulmonary function. Egypt J Anaesth. 2005;21:277–81.Google Scholar
  51. 51.
    Huot MP, Chouinard P, Girard F, et al. Gabapentin does not reduce post-thoracotomy shoulder pain: a randomized, double-blind placebo-controlled study. Can J Anaesth. 2008;55(6):337–43.Google Scholar
  52. 52.
    Zhang J, Ho KY, Wang Y. Efficacy of pregabalin in acute postoperative pain: a meta-analysis. Br J Anaesth. 2011;106(4):454–62.PubMedGoogle Scholar
  53. 53.
    Mishriky BM, Waldron NH, Habib AS. Impact of pregabalin on acute and persistent postoperative pain: a systematic review and meta-analysis. Br J Anaesth. 2015;114(1):10–31.PubMedGoogle Scholar
  54. 54.
    Baidya DK, Agarwal A, Khanna P, et al. Pregabalin in acute and chronic pain. J Anaesthesiol Clin Pharmacol. 2011;27(3):307–14.Google Scholar
  55. 55.
    Singla NK, Chelly JE, Lionberger DR, et al. Pregabalin for the treatment of postoperative pain: results from three controlled trials using different surgical models. J Pain Res. 2015;8:9–20.Google Scholar
  56. 56.
    Wahlander S, Frumento RJ, Wagener G, et al. A prospective, double-blind, randomized, placebo-controlled study of dexmedetomidine as an adjunct to epidural analgesia after thoracic surgery. J Cardiothorac Vasc Anesth. 2005;19(5):630–5.Google Scholar
  57. 57.
    Dong CS, Zhang J, Lu Q, et al. Effect of dexmedetomidine combined with sufentanil for post-thoracotomy intravenous analgesia:a randomized, controlled clinical study. BMC Anesthesiol. 2017;17(1):33.Google Scholar
  58. 58.
    Talbot RM, McCarthy KF, McCrory C. Central and systemic inflammatory responses to thoracotomy—potential implications for acute and chronic postsurgical pain. J Neuroimmunol. 2015;285:147–9.PubMedGoogle Scholar
  59. 59.
    Hong D, Byers MR, Oswald RJ. Dexamethasone treatment reduces sensory neuropeptides and nerve sprouting reactions in injured teeth. Pain. 1993;55(2):171–81.PubMedGoogle Scholar
  60. 60.
    Marek P, Ben-Eliyahu S, Vaccarino AL, et al. Delayed application of MK-801 attenuates development of morphine tolerance in rats. Brain Res. 1991;558(1):163–5.Google Scholar
  61. 61.
    Rasmussen SB, Saied NN, Bowens C Jr, et al. Duration of upper and lower extremity peripheral nerve blockade is prolonged with dexamethasone when added to ropivacaine: a retrospective database analysis. Pain Med. 2013;14(8):1239–47.Google Scholar
  62. 62.
    Tomar GS, Ganguly S, Cherian G. Effect of perineural dexamethasone with bupivacaine in single space paravertebral block for postoperative analgesia in elective nephrectomy cases: a double-blind placebo-controlled trial. Am J Ther. 2017;24:e713–7.PubMedGoogle Scholar
  63. 63.
    Ballantyne JC, Carr DB, deFerranti S, et al. The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesth Analg. 1998;86(3):598–612.Google Scholar
  64. 64.
    Bauer C, Hentz JG, Ducrocq X, et al. Lung function after lobectomy: a randomized, double-blinded trial comparing thoracic epidural ropivacaine/sufentanil and intravenous morphine for patient-controlled analgesia. Anesth Analg. 2007;105(1):238–44.Google Scholar
  65. 65.
    Gough JD, Williams AB, Vaughan RS, et al. The control of post-thoracotomy pain. A comparative evaluation of thoracic epidural fentanyl infusions and cryo-analgesia. Anaesthesia. 1988;43(9):780–3.Google Scholar
  66. 66.
    Muller LC, Salzer GM, Ransmayr G, et al. Intraoperative cryoanalgesia for postthoracotomy pain relief. Ann Thorac Surg. 1989;48(1):15–8.Google Scholar
  67. 67.
    Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150(3699):971–9.PubMedGoogle Scholar
  68. 68.
    Rodriguez-Aldrete D, Candiotti KA, Janakiraman R, et al. Trends and new evidence in the management of acute and chronic post-thoracotomy pain-an overview of the literature from 2005 to 2015. J Cardiothorac Vasc Anesth. 2016;30(3):762–72.Google Scholar
  69. 69.
    Fiorelli A, Morgillo F, Milione R, et al. Control of post-thoracotomy pain by transcutaneous electrical nerve stimulation: effect on serum cytokine levels, visual analogue scale, pulmonary function and medication. Eur J Cardiothorac Surg. 2012;41(4):861–8.Google Scholar
  70. 70.
    Sbruzzi G, Silveira SA, Silva DV, et al. Transcutaneous electrical nerve stimulation after thoracic surgery: systematic review and meta-analysis of 11 randomized trials. Rev Bras Cir Cardiovasc. 2012;27(1):75–87.Google Scholar
  71. 71.
    Cook TM, Eaton JM. Epidural analgesia after thoracotomy: United Kingdom practice. Eur J Anaesthesiol. 1997;14(1):108–11.PubMedGoogle Scholar
  72. 72.
    Yeung JH, Gates S, Naidu BV, et al. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev. 2016;2:CD009121.Google Scholar
  73. 73.
    Cook TM, Counsell D, Wildsmith JA, Royal College of Anaesthetists Third National Audit Project. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists. Br J Anaesth. 2009;102(2):179–90.PubMedGoogle Scholar
  74. 74.
    Counsell D. Complications after perioperative central neuraxial blocks. The Third National Audit Project (NAP3), editor. Major complications of central neuraxial blocks in the United Kingdom. London: Royal College of Anaesthetists; 2009. pp. 101–11.Google Scholar
  75. 75.
    Scarci M, Joshi A, Attia R. In patients undergoing thoracic surgery is paravertebral block as effective as epidural analgesia for pain management? Interact Cardiovasc Thorac Surg. 2010;10(1):92–6.PubMedGoogle Scholar
  76. 76.
    Daly DJ, Myles PS. Update on the role of paravertebral blocks for thoracic surgery: are they worth it? Curr Opin Anaesthesiol. 2009;22(1):38–43.PubMedGoogle Scholar
  77. 77.
    Bai Y, Miller T, Tan M, et al. Lidocaine patch for acute pain management: a meta-analysis of prospective controlled trials. Curr Med Res Opin. 2015;31(3):575–81.Google Scholar
  78. 78.
    Vrooman B, Kapural L, Sarwar S, et al. Lidocaine 5% patch for treatment of acute pain after robotic cardiac surgery and prevention of persistent incisional pain: a randomized, placebo-controlled. Double-Blind Trial Pain Med. 2015;16(8):1610–21.Google Scholar
  79. 79.
    Fiorelli A, Izzo AC, Frongillo EM, et al. Efficacy of wound analgesia for controlling post-thoracotomy pain: a randomized double-blind studydagger. Eur J Cardiothorac Surg. 2016;49(1):339–47.Google Scholar
  80. 80.
    Liu SS, Richman JM, Thirlby RC, et al. Efficacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: a quantitative and qualitative systematic review of randomized controlled trials. J Am Coll Surg. 2006;203(6):914–32.Google Scholar
  81. 81.
    Angst MS, Drover DR. Pharmacology of drugs formulated with DepoFoam®: a sustained release drug delivery system for parenteraladministration using multivesicular liposome technology. Clin Pharmacokinet. 2006;45(12):1153–76.PubMedGoogle Scholar
  82. 82.
    Lambert WJ, Los K. DepoFoam® multivesicular liposomes for the sustained release of macromolecules. In: Rathbone MJ, et al., editors. Modified-releasedrug delivery technology, vol. 2. 2nd ed. New York: Informa Healthcare; 2008. p. 207–14.Google Scholar
  83. 83.
    Bergese S, Onel E, Portillo J. Evaluation of DepoFoam® bupivacainefor the treatment of postsurgical pain. Pain Manag. 2011;1(6):539–47.PubMedGoogle Scholar
  84. 84.
    Chahar P, Cummings KC III. Liposomal bupivacaine: a review of anew bupivacaine formulation. J Pain Res. 2012;5:257–64.PubMedPubMedCentralGoogle Scholar
  85. 85.
    Kvalheim LR, Reiestad F. Intrapleural catheter in the management of postoperative pain. Anesthesiology. 1984;61:A231.Google Scholar
  86. 86.
    Miguel R, Smith R. Intrapleural, not interpleural, analgesia. Reg Anesth. 1991;16(5):299.PubMedGoogle Scholar
  87. 87.
    Baumgarten RK. Intrapleural, interpleural, or pleural block? Simpler may be better. Reg Anesth. 1992;17(2):116.PubMedGoogle Scholar
  88. 88.
    Dravid RM, Paul RE. Interpleural block—part 1. Anaesthesia. 2007;62(10):1039–49.PubMedGoogle Scholar
  89. 89.
    Pennefather SH, Akrofi ME, Kendall JB, et al. Double-blind comparison of intrapleural saline and 0.25% bupivacaine for ipsilateral shoulder pain after thoracotomy in patients receiving thoracic epidural analgesia. Br J Anaesth. 2005;94(2):234–8.Google Scholar
  90. 90.
    Kambam JR, Hammon J, Parris WC, et al. Intrapleural analgesia for post-thoracotomy pain and blood levels of bupivacaine following intrapleural injection. Can J Anaesth. 1989;36(2):106–9.Google Scholar
  91. 91.
    Broome IJ, Sherry KM, Reilly CS. A combined chest drain and intrapleural catheter for post-thoracotomy pain relief. Anaesthesia. 1993;48(8):724–6.PubMedGoogle Scholar
  92. 92.
    Chin KJ, Malhas L, Perlas A. The erector spinae plane block provides visceral abdominal analgesia in bariatric surgery, a report of 3 cases. Reg Anesth Pain Med. 2017;42(3):372–6.PubMedGoogle Scholar
  93. 93.
    Forero M, Rajarathinam M, Adhikary S, et al. Continuous erector spinae plane block for rescue analgesia in thoracotomy after epidural failure: a case report. A&A Case Rep. 2017;8:254–6.Google Scholar
  94. 94.
    Gustafsson LL, Wiesenfeld-Hallin Z. Spinal opioid analgesia. A critical update. Drugs. 1988;35(6):597–603.PubMedGoogle Scholar
  95. 95.
    Cousins MJ, Mather LE. Intrathecal and epidural administration of opioids. Anesthesiology. 1984;61(3):276–310.PubMedGoogle Scholar
  96. 96.
    Dryden CM, McMenemin I, Duthie DJ. Efficacy of continuous intercostal bupivacaine for pain relief after thoracotomy. Br J Anaesth. 1993;70(5):508–10.PubMedGoogle Scholar
  97. 97.
    Blanco R, Parras T, McDonnell JG, et al. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block. Anaesthesia. 2013;68(11):1107–13.Google Scholar
  98. 98.
    Okmen K, Okmen BM. The efficacy of serratus anterior plane block in analgesia for thoracotomy: a retrospective study. J Anesth. 2017;31(4):579–85.PubMedGoogle Scholar
  99. 99.
    Madabushi R, Tewari S, Gautam SK, et al. Serratus anterior plane block: a new analgesic technique for post-thoracotomy pain. Pain Physician. 2015;18(3):E421–4.Google Scholar
  100. 100.
    Lonnqvist PA, Hildingsson U. The caudal boundary of the thoracic paravertebral space. A study in human cadavers. Anaesthesia. 1992;47(12):1051–2.PubMedGoogle Scholar
  101. 101.
    Karmakar MK. Thoracic paravertebral block. Anesthesiology. 2001;95(3):771–80.PubMedGoogle Scholar
  102. 102.
    Hutchins J, Sanchez J, Andrade R, et al. Ultrasound-guided paravertebral catheter versus intercostals blocks for postoperative pain control in video-assisted thoracoscopic surgery: a prospective randomized trial. J Cardiothorac Vasc Anesth. 2017;31(2):458–63.Google Scholar
  103. 103.
    Davies RG, Myles PS, Graham JM. A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy—a systematic review and meta-analysis of randomized trials. Br J Anaesth. 2006;96(4):418–26.PubMedGoogle Scholar
  104. 104.
    Ding X, Jin S, Niu X, et al. A comparison of the analgesia efficacy and side effects of paravertebral compared with epidural blockade for thoracotomy: an updated meta-analysis. PLoS One. 2014;9(5):e96233.Google Scholar
  105. 105.
    Baidya DK, Khanna P, Maitra S. Analgesic efficacy and safety of thoracic paravertebral and epidural analgesia for thoracic surgery: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg. 2014;18(5):626–35.PubMedGoogle Scholar
  106. 106.
    Okajima H, Tanaka O, Ushio M, et al. Ultrasound-guided continuous thoracic paravertebral block provides comparable analgesia and fewer episodes of hypotension than continuous epidural block after lung surgery. J Anesth. 2015;29(3):373–8.Google Scholar
  107. 107.
    Eason MJ, Wyatt R. Paravertebral thoracic block-a reappraisal. Anaesthesia. 1979;34(7):638–42.PubMedGoogle Scholar
  108. 108.
    Sabanathan S, Smith PJ, Pradhan GN, et al. Continuous intercostal nerve block for pain relief after thoracotomy. Ann Thorac Surg. 1988;46(4):425–6.Google Scholar
  109. 109.
    Soni AK, Conacher ID, Waller DA, et al. Video-assisted thoracoscopic placement of paravertebral catheters: a technique for postoperative analgesia for bilateral thoracoscopic surgery. Br J Anaesth. 1994;72(4):462–4.Google Scholar
  110. 110.
    Yamauchi Y, Isaka M, Ando K, et al. Continuous paravertebral block using a thoracoscopic catheter-insertion technique for postoperative pain after thoracotomy: a retrospective case-control study. J Cardiothorac Surg. 2017;12(1):5.Google Scholar
  111. 111.
    Cowie B, McGlade D, Ivanusic J, et al. Ultrasound-guided thoracic paravertebral blockade: a cadaveric study. Anesth Analg. 2010;110(6):1735–9.Google Scholar
  112. 112.
    Krediet AC, Moayeri N, van Geffen GJ, et al. Different approaches to ultrasound-guided thoracic paravertebral block: an illustrated review. Anesthesiology. 2015;123(2):459–74.Google Scholar
  113. 113.
    Riain SCO, Donnell BO, Cuffe T, et al. Thoracic paravertebral block using real-time ultrasound guidance. Anesth Analg. 2010;110(1):248–51.Google Scholar
  114. 114.
    Taketa Y, Fujitani T, Irisawa Y, et al. Ultrasound-guided thoracic paravertebral block by the paralaminar in-plane approach using a microconvex array transducer: methodological utility based on anatomical structures. J Anesth. 2017;31(2):271–7.Google Scholar
  115. 115.
    Kaya FN, Turker G, Mogol EB, et al. Thoracic paravertebral block for video-assisted thoracoscopic surgery: single injection versus multiple injections. J Cardiothorac Vasc Anesth. 2012;26(1):90–4.Google Scholar
  116. 116.
    Vogt A, Stieger DS, Theurillat C, et al. Single-injection thoracic paravertebral block for postoperative pain treatment after thoracoscopic surgery. Br J Anaesth. 2005;95(6):816–21.Google Scholar
  117. 117.
    Fibla JJ, Molins L, Mier JM, et al. A randomized prospective study of analgesic quality after thoracotomy: paravertebral block with bolus versus continuous infusion with an elastomeric pump. Eur J Cardiothorac Surg. 2015;47(4):631–5.Google Scholar
  118. 118.
    Griffiths DP, Diamond AW, Cameron JD. Postoperative extradural analgesia following thoracic surgery: a feasibility study. Br J Anaesth. 1975;47(1):48–55.PubMedGoogle Scholar
  119. 119.
    Shuman RL, Peters RM. Epidural anesthesia following thoracotomy in patients with chronic obstructive airway disease. J Thorac Cardiovasc Surg. 1976;71(1):82–8.PubMedGoogle Scholar
  120. 120.
    Hoffmann VL, Vercauteren MP, Vreugde JP, et al. Posterior epidural space depth: safety of the loss of resistance and hanging drop techniques. Br J Anaesth. 1999;83:807–9.PubMedGoogle Scholar
  121. 121.
    Leurcharusmee P, Arnuntasupakul V, Chora De La Garza D, et al. Reliabilty of waveform analysis as an adjunct to loss of resistance for thoracic epidural blocks. Reg Anesth Pain Med. 2015;40:694–7.PubMedGoogle Scholar
  122. 122.
    Pennefather SH, Gilby S, Danecki A, et al. The changing practice of thoracic epidural analgesia in the United Kingdom: 1997–2004. Anaesthesia. 2006;61(4):363–9.Google Scholar
  123. 123.
    Eisenach JC, De Kock M, Klimscha W. Alpha(2)-adrenergic agonists for regional anesthesia. A clinical review of clonidine (1984–1995). Anesthesiology. 1996;85(3):655–74.PubMedGoogle Scholar
  124. 124.
    Neil MJ. Clonidine: clinical pharmacology and therapeutic use in pain management. Curr Clin Pharmacol. 2011;6(4):280–7.PubMedGoogle Scholar
  125. 125.
    Mohammad W, Mir SA, Mohammad K, et al. A randomized double-blind study to evaluate efficacy and safety of epidural magnesium sulfate and clonidine as adjuvants to bupivacaine for postthoracotomy pain relief. Anesth Essays Res. 2015;9(1):15–20.Google Scholar
  126. 126.
    Bromage PR, Camporesi EM, Durant PA, et al. Nonrespiratory side effects of epidural morphine. Anesth Analg. 1982;61(6):490–5.Google Scholar
  127. 127.
    Yaksh TL. Spinal opiate analgesia: characteristics and principles of action. Pain. 1981;11(3):293–346.PubMedGoogle Scholar
  128. 128.
    Bonica JJ. Autonomic innervation of the viscera in relation to nerve block. Anesthesiology. 1968;29(4):793–813.PubMedGoogle Scholar
  129. 129.
    Jorgensen H, Wetterslev J, Moiniche S, et al. Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery. Cochrane Database Syst Rev. 2000;4:CD001893.Google Scholar
  130. 130.
    Zeng XZ, Lu ZF, Lv XQ, et al. Epidural Co-administration of dexmedetomidine and levobupivacaine improves the gastrointestinal motility function after colonic resection in comparison to co-administration of morphine and levobupivacaine. PLoS One. 2016;11(1):e0146215.Google Scholar
  131. 131.
    Lundberg JF, Martner J, Raner C, et al. Dopamine or norepinephrine infusion during thoracic epidural anesthesia? Differences in hemodynamic effects and plasma catecholamine levels. Acta Anaesthesiol Scand. 2005;49(7):962–8.Google Scholar
  132. 132.
    Li XQ, Tan WF, Wang J, et al. The effects of thoracic epidural analgesia on oxygenation and pulmonary shunt fraction during one-lung ventilation: an meta-analysis. BMC Anesthesiol. 2015;15:166.Google Scholar
  133. 133.
    Magnano D, Montalbano R, Lamarra M, et al. Ineffectiveness of local wound anesthesia to reduce postoperative pain after median sternotomy. J Card Surg. 2005;20(4):314–8.Google Scholar
  134. 134.
    McDonald SB, Jacobsohn E, Kopacz DJ, et al. Parasternal block and local anesthetic infiltration with levobupivacaine after cardiac surgery with desflurane: the effect on postoperative pain, pulmonary function, and tracheal extubation times. Anesth Analg. 2005;100(1):25–32.Google Scholar
  135. 135.
    Ziyaeifard M, Azarfarin R, Golzari SE. A review of current analgesic techniques in cardiac surgery. Is epidural worth it? J Cardiovasc Thorac Res. 2014;6(3):133–40.PubMedPubMedCentralGoogle Scholar
  136. 136.
    Steinthorsdottir KJ, Wildgaard L, Hansen HJ, et al. Regional analgesia for video-assisted thoracic surgery: a systematic review. Eur J Cardiothorac Surg. 2014;45(6):959–66.Google Scholar
  137. 137.
    Zingg U, McQuinn A, DiValentino D, et al. Minimally invasive versus open esophagectomy for patients with esophageal cancer. Ann Thorac Surg. 2009;87(3):911–9.Google Scholar
  138. 138.
    Mahon SV, Berry PD, Jackson M, et al. Thoracic epidural infusions for post-thoracotomy pain: a comparison of fentanyl-bupivacaine mixtures vs. fentanyl alone. Anaesthesia. 1999;54(7):641–6.Google Scholar
  139. 139.
    Tan CN, Guha A, Scawn ND, et al. Optimal concentration of epidural fentanyl in bupivacaine 0.1% after thoracotomy. Br J Anaesth. 2004;92(5):670–4.Google Scholar
  140. 140.
    Samii K, Feret J, Harari A, et al. Selective spinal analgesia. Lancet. 1979;1(8126):1142.Google Scholar
  141. 141.
    Neustein SM, Cohen E. Intrathecal morphine during thoracotomy, Part II: effect on postoperative meperidine requirements and pulmonary function tests. J Cardiothorac Vasc Anesth. 1993;7(2):157–9.PubMedGoogle Scholar
  142. 142.
    Liu M, Rock P, Grass JA, et al. Double-blind randomized evaluation of intercostal nerve blocks as an adjuvant to subarachnoid administered morphine for post-thoracotomy analgesia. Reg Anesth. 1995;20(5):418–25.Google Scholar
  143. 143.
    Cense HA, Lagarde SM, de Jong K, et al. Association of no epidural analgesia with postoperative morbidity and mortality after transthoracic esophageal cancer resection. J Am Coll Surg. 2006;202(3):395–400.Google Scholar
  144. 144.
    Li W, Li Y, Huang Q, et al. Short and long-term outcomes of epidural or intravenous analgesia after esophagectomy: a propensity-matched cohort study. PLoS One. 2016;11(4):e0154380.Google Scholar
  145. 145.
    Scawn ND, Pennefather SH, Soorae A, et al. Ipsilateral shoulder pain after thoracotomy with epidural analgesia: the influence of phrenic nerve infiltration with lidocaine. Anesth Analg. 2001;93(2):260–4.Google Scholar
  146. 146.
    Tan N, Agnew NM, Scawn ND, et al. Suprascapular nerve block for ipsilateral shoulder pain after thoracotomy with thoracic epidural analgesia: a double-blind comparison of 0.5% bupivacaine and 0.9% saline. Anesth Analg. 2002;94(1):199–202.Google Scholar
  147. 147.
    Blichfeldt-Eckhardt MR, Andersen C, Ording H, et al. Shoulder pain after thoracic surgery: type and time course, a prospective cohort study. J Cardiothorac Vasc Anesth. 2017;31(1):147–51.Google Scholar
  148. 148.
    Danelli G, Berti M, Casati A, et al. Ipsilateral shoulder pain after thoracotomy surgery: a prospective, randomized, double-blind, placebo-controlled evaluation of the efficacy of infiltrating the phrenic nerve with 0.2%wt/volropivacaine. Eur J Anaesthesiol. 2007;24(7):596–601.Google Scholar
  149. 149.
    Mac TB, Girard F, Chouinard P, et al. Acetaminophen decreases early post-thoracotomy ipsilateral shoulder pain in patients with thoracic epidural analgesia: a double-blind placebo-controlled study. J Cardiothorac Vasc Anesth. 2005;19(4):475–8.Google Scholar
  150. 150.
    Urmey WF, McDonald M. Hemidiaphragmatic paresis during interscalene brachial plexus block: effects on pulmonary function and chest wall mechanics. Anesth Analg. 1992;74(3):352–7.PubMedGoogle Scholar
  151. 151.
    Garner L, Coats RR. Ipsilateral stellate ganglion block effective for treating shoulder pain after thoracotomy. Anesth Analg. 1994;78(6):1195–6.PubMedGoogle Scholar
  152. 152.
    Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl. 1986;3:S1–226.Google Scholar
  153. 153.
    Katz J, Jackson M, Kavanagh BP, et al. Acute pain after thoracic surgery predicts long-term post-thoracotomy pain. Clin J Pain. 1996;12(1):50–5.Google Scholar
  154. 154.
    Gottschalk A, Cohen SP, Yang S, et al. Preventing and treating pain after thoracic surgery. Anesthesiology. 2006;104(3):594–600.Google Scholar
  155. 155.
    Perttunen K, Tasmuth T, Kalso E. Chronic pain after thoracic surgery: a follow-up study. Acta Anaesthesiol Scand. 1999;43(5):563–7.PubMedGoogle Scholar
  156. 156.
    Furrer M, Rechsteiner R, Eigenmann V, et al. Thoracotomy and thoracoscopy: postoperative pulmonary function, pain and chest wall complaints. Eur J Cardiothorac Surg. 1997;12(1):82–7.Google Scholar
  157. 157.
    Forster R, Storck M, Schafer JR, et al. Thoracoscopy versus thoracotomy: a prospective comparison of trauma and quality of life. Langenbeck’s Arch Surg. 2002;387(1):32–6.Google Scholar
  158. 158.
    Hetmann F, Kongsgaard UE, Sandvik L, et al. Post-thoracotomy pain syndrome and sensory disturbances following thoracotomy at 6- and 12-month follow-ups. J Pain Res. 2017;10:663–8.Google Scholar
  159. 159.
    Hetmann F, Kongsgaard UE, Sandvik L, et al. Prevalence and predictors of persistent post-surgical pain 12 months after thoracotomy. Acta Anaesthesiol Scand. 2015;59(6):740–8.Google Scholar
  160. 160.
    Hoofwijk DM, van Reij RR, Rutten BP, et al. Genetic polymorphisms and their association with the prevalence and severity of chronic postsurgical pain: a systematic review. Br J Anaesth. 2016;117(6):708–19.Google Scholar
  161. 161.
    Kehlet H, Wilkinson RC, Fischer HB, et al. Prospect Working Group. PROSPECT: evidence-based, procedure-specific postoperative pain management. Best Pract Res Clin Anaesthesiol. 2007;21(1):149–59.Google Scholar
  162. 162.
    Mishra A, Nar AS, Bawa A, et al. Pregabalin in chronic post-thoracotomy pain. J Clin Diagn Res. 2013;7:1659–61.Google Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  • Manish Kohli
    • 1
  • Pradeep Jain
    • 1
  1. 1.Institute of Anaesthesiology, Pain and Perioperative MedicineSir Ganga Ram HospitalNew DelhiIndia

Personalised recommendations