Opioid-sparing opportunities in the thoracic surgery pathway

[摘要] Pain control is an important component of postoperative care after all types of surgery and becomes particularly crucial in the management of the thoracic surgery patient. Pain must be properly addressed in these patients to allow for full re-expansion of the lungs, mucus expectoration, and prevent complications such as pneumonia. The introduction of video-assisted thoracic surgery (VATS) as a minimally invasive approach has led to great improvements in postoperative pain, recovery time, and complications compared to open thoracotomy, though it does come with its own challenges. Compression and retraction on the intercostal nerves, edema around the incision sites, and damage to the muscle fibers all contribute to pain experienced after VATS, and some go on to develop chronic neuropathic pain. The rate of chronic postsurgical pain, defined as pain persisting at least 3 months after surgery, occurs in 20% to 47% of patients after VATS, and has been found to be correlated with severe pain on the first day after surgery (1). This further underscores the importance of postoperative pain control. There is a careful balance to strike in designing a pain control regimen with adequate analgesia to allow for frequent ambulation and pulmonary hygiene, while also limiting the harmful side effects of opioid medications such as drowsiness, respiratory compromise, constipation, and dependence.

[学科分类] 呼吸医学

[关键词] Anesthesia;opioid-sparing;thoracic surgery;video-assisted thoracic surgery (VATS)