Pain Management After Thoracic Surgery

  • Stephen H. Pennefather
  • Clare Paula-Jo QuartermanEmail author
  • Rebecca Y. Klinger
  • George W. Kanellakos


Thoracic surgery can cause significant pain and suffering. Appropriate analgesia is important both for humanitarian reasons and to allow early mobilization and pulmonary rehabilitation. Poor pain relief can increase pulmonary complications and mortality. Pain after thoracic surgery is generated from multiple structures and is transmitted via a number of afferent pathways. Factors that affect pain postoperatively can be divided into patient factors, analgesic technique, and surgical approach. Paravertebral catheters and thoracic epidural analgesia are widely used for thoracotomies and both have advantages and disadvantages. Recent studies suggest a similar quality of pain relief between the two approaches but a preferable side effect profile where paravertebral analgesia is utilized. Opioid-tolerant patients pose a particular challenge. Maintenance opioid should be continued perioperatively to avoid withdrawal symptoms. A multimodal technique involving regional blocks and supplemented with non-opioid analgesics is advised.


Pain Multimodal analgesia Epidural Paravertebral Regional 



Association of Anaesthetists of Great Britain and Ireland


Adrenocorticotropic hormone


Antidiuretic hormone


American Society of Regional Anesthesia and Pain Medicine




European Society of Anaesthesiology


Forced expiratory volume in 1 second


Functional residual capacity


Forced vital capacity


Heart rate








Intravenous patient-controlled analgesia




Nonsteroidal anti-inflammatory drugs


Pulmonary function tests


Transcutaneous nerve stimulation


Tumor necrosis factor alpha


Ventilation/perfusion ratio


Video-assisted thoracoscopic surgery

Supplementary material

Video 59.1

Surgical placement of a paravertebral catheter during VATS. The same technique can also be used during open thoracotomy (Video courtesy of Dr. G. Kanellakos) (MP4 78828 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Stephen H. Pennefather
    • 1
  • Clare Paula-Jo Quarterman
    • 2
    Email author
  • Rebecca Y. Klinger
    • 3
  • George W. Kanellakos
    • 4
  1. 1.Department of AnesthesiaLiverpool Heart and Chest HospitalLiverpoolUK
  2. 2.Department of AnaesthesiaLiverpool Heart and Chest NHS Foundation TrustLiverpoolUK
  3. 3.Department of AnesthesiologyDuke University Medical CenterDurhamUSA
  4. 4.Department of AnesthesiaPain Management & Perioperative Medicine, Dalhousie UniversityHalifaxCanada

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