pain after thoracotomy is very severe, probably the most severe pain experienced after surgery. It is also unique as this pain state has multiple implications, including respiratory failure due to splinting; inability to clear secretions by effective coughing, with resulting pneumonia; and facilitation of the often incapacitating chronic pain: the post-thoracotomy pain syndrome. A thoracotomy requires a very painful incision, involving multiple muscle layers, rib resection, and continuous motion as the patient breathes. Treatment of acute post-thoracotomy pain is particularly important not only to keep the patient comfortable but also to minimize pulmonary complications. Many methods of pain management, each with attendant problems, have been tried with varied success, for example: intercostal nerve block, intrapleural analgesia, cryo-analgesia, lumbar epidural, thoracic epidural, paravertebral block, IV narcotics, intrathecal or epidural narcotics, NSAIDS, and transcutaneous nerve stimulation. Continuous thoracic paravertebral blockade is an advanced regional anaesthesia technique and adequate experience with the single-shot technique is a prerequisite. The continuous thoracic paravertebral block technique is more suitable for analgesia than for surgical anaesthesia. The technique is somewhat similar to the single-shot injection, except that the needle should be properly angled to allow for insertion of the catheter. This technique provides excellent analgesia and it is devoid of significant hemodynamic effects in patients after mastectomy and unilateral chest surgery. |
