Post thoracotomy pain management: A review of current available modalities

Pain after thoracotomy is probably the most severe pain experienced by the patient as incision penetrate several layers of muscle tissue, neurovascular bundles and other structures of the thoracic region. It may be sharp, stabbing, constant shooting neuropathic pain which can be acute (within 30 days of thoracotomy) or chronic (2 to 6 months after thoracotomy). Because of pain, there is shallow breathing and inadequate coughing leading to various types of pulmonary function impairment and complications like retention of secretions, atelectasis, hypoxemia, hypercarbia, respiratory failure and increased chances of re-intubation. Pain also leads to longer stay in the intensive care unit and a delayed mobilization of the patient which ultimately causes increased morbidity and mortality. The chances of deep vein thrombosis are also increased because of delayed mobilization. Sometimes patient may experience post thoracotomy pain syndrome along with changes in psychological behaviour like depression. So management of pain relief is very essential to resume normal activities as soon as possible. This will also lead to increased overall patient’s satisfaction. In this article we have highlighted various causes of pain in thoracotomy, its pathophysiology and modalities to relieve pain. This review article aims to highlight all the current practices and modalities so as to manage post-operative pain of thoracotomy in a better manner.