Acute and chronic pain syndromes after thoracic surgery

Thoracic operations have been considered to be among the most painful surgical incisions [1-4]. Inadequate pain control not only creates discomfort for the patient, but it might also result in a reduction of lung function, impairment of respiratory effort, atelectasis, and hypoxemia [1,2,5,6]. These complications are particularly prominent in patients who have a significant history of smoking, obesity, old age, and pre-existing cardiovascular disease. In addition to lung-related morbidity, poorly controlled pain is also associated with an increased level of catecholamine release, increased afterload, increased myocardial oxygen demand, arrhythmias, myocardial dysfunction, and abnormalities in coagulation profiles [1,2]. Immobilization because of pain leads to an increased incidence of deep venous thrombosis and pulmonary embolus. All of these adverse events result in increased morbidity, mortality, prolonged hospital stays, and increased cost. Hence, prompt and objective evaluation of acute pain, an understanding of the pathophysiology of pain, selecting the least painful surgical approach, and optimal pain management are essential in the total care of postoperative thoracic patients. This article describes the common etiologies of acute and chronic postthoracotomy pain, perioperative considerations to prevent postsurgical pain, and the different analgesic modalities utilized after thoracic surgery.