The State of the Art in Preventing Postthoracotomy Pain

Alan Romero, Jose Enrique L Garcia, Girish P. Joshi

Research output: Contribution to journalArticlepeer-review

40 Scopus citations


Pain after thoracic surgery can be intense and prolonged. Inadequate pain management can have several detrimental effects, including increased postoperative morbidity and delayed recovery as well as occurrence of postthoracotomy syndrome. Therefore, establishing an adequate analgesic regimen for thoracic surgery is critical. Thoracic paravertebral block or thoracic epidural analgesia is recommended as the first-choice therapies for postthoracotomy analgesia. When these techniques are either contraindicated or not possible, intercostal analgesia or intrathecal opioids are recommended. These techniques should be combined with nonopioid analgesics, such as acetaminophen, nonsteroidal anti-inflammatory drugs, or cyclooxygenase-2-specific inhibitors, administered on a regular "round-the-clock" basis, with opioids used as "rescue" analgesics. Finally, the integration of multimodal analgesia techniques with multidisciplinary rehabilitation program can enhance recovery, reduce hospital stay, and facilitate early convalescence.

Original languageEnglish (US)
Pages (from-to)116-124
Number of pages9
JournalSeminars in Thoracic and Cardiovascular Surgery
Issue number2
StatePublished - Nov 19 2013


  • COX-2 inhibitors
  • NSAIDs
  • Opioids
  • Postoperative pain
  • Regional analgesia
  • Thoracotomy

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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