Postthoracotomy Pain: The Unanswered Question Yet – A Clinical and Technical Report

Abstract Thoracotomy which is a major surgical procedure of making an incision through the thoracic wall in order to gain access to the thoracic organs, is a cornerstone of diagnosis and management of numerous cardiopulmonary disorders. Nonetheless, most essential area of patient care, postoperative pain management, presents several obstacles. Published literature shows that about three-quarters of the thoracotomy patients reported immediate pain or discomfort during the early postoperative period, and up to 30%–50% patients might even develop chronic pain that has implications on their health related quality of life. Consequently, the causes of continued pain after thoracotomy are numerous and range from the intricacy of the procedure, patients’ tolerance to pain and diseases among others. Pain control is essential to avoid the risk of the deterioration of lung function, poor patient mobilization, and prolonged hospital stay. It is therefore undoubted that if pain continues for a long period, one may develop chronic pain syndromes that drag down the quality of life even further. In attempts to resolve these problems, different types of analgesic measures have been attempted. Some interventional procedures have been reported recently to be useful: Fascial plane blocks, which interfere with the flow of pain messages. Routes such as thoracic paravertebral block, intercostal nerve block, serratus anterior plane block, pectoral nerve block, and the retrolaminar block give variable levels of anesthesia in the required area. Some newer blocks such as the rhomboid intercostal and serratus sparing (RISS) block seem to provide a wide complete analgesia of the posterior and lateral chest walls. Thus, in an intermediate-term pain management strategy, fascial plane blocks can be used together with medications such as paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs). It is a kind-of medicine that is frequently used because of its effectiveness accompanied by a tendency to produce minimal side effects and interact well with opioids without posing the risks inherent in the application of NSAIDs. They have significant analgesic and anti-inflammatory properties thus decreasing the dependence on opioids. Their use, therefore, comes with a lot of precautions due, prompt for example per both gastrointestinal bleeding and renal impairment, hence, requires patient spotlight and assessment. Therefore, in enhancing postthoracotomy pain regime, a multimodal approach that includes the use of fascial plane blocks in combination with paracetamol and prudent use of NSAID can improve the recovery process and henceforth the patient’s outcomes without subjecting the patients to adverse effects.