Post thoracotomy pain has different origins. Its impulses originate from the chest wall and parietal pleura pass along the intercostal nerves; in addition to those originating from diaphragmatic pleura ascend within the afferent fibers within the phrenic nerves, and those from the lung and mediastinum are carried by the vagus nerve. Surgical techniques influence the nature and intensity of post operative pain. A systematic review of published literature suggested that an optimal pain regimen would include regional anesthetic techniques such as thoraci epidural anelgesia (TEA) or paravrtebral block. Multimodal analgesia involves the use of analgesics with different mechanisms of action to provide superior dynamic pain relief with reduced analgesic related adverse effects. Tha analgesic modalities available for postoperative pain management after thoracic surgery include regional or local analgesia techniques, such as epidural analgesia, paravertebral analgesia, intercostal nerve blocks (ICNB) and wound infiltration. |
