Chapter 28 - Pain management after thoracotomy

Summary

This chapter provides an account of locations of pain after thoracotomy, operative considerations relevant to pain relief, and current methods of analgesia. Ipsilateral shoulder pain after thoracotomy is a frequent problem. It is of at least moderate intensity and occurs despite blockade of the suprascapular nerve supplying the shoulder. From the analgesic perspective, operative considerations may be classified into standard posterolateral thoracotomy and muscle-sparing thoracotomy. During a standard posterolateral thoracotomy, division of latissismus dorsi is required to obtain access to the intercostal space. The skin incision of a muscle-sparing thoracotomy traverses two to three dermatomes whereas that of the standard approach is over one dermatome. The main methods of analgesia are paravertebral analgesia, intrathecal opioids, epidural blockade, and analgesic adjuncts. Shoulder pain and chronic pain after thoracotomy are common. To manage pain after thoracotomy, the main methods of analgesia comprise epidural blockade and local anesthetics in the ipsilateral paravertebral space.