Show Summary Details
Page of

Pain relief after thoracic and cardiac surgery 

Pain relief after thoracic and cardiac surgery
Chapter:
Pain relief after thoracic and cardiac surgery
Author(s):

Desmond P. McGlade

and David A. Scott

DOI:
10.1093/med/9780199653478.003.0038
Page of

PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2016. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy and Legal Notice).

date: 15 October 2019

Thoracotomy produces significant acute postoperative pain, which may progress to chronic pain. Multimodal analgesia is recommended, ideally using a combination of regional and systemic analgesia. Thoracic epidural analgesia remains the gold standard although thoracic paravertebral block has gained support, with evidence demonstrating similar analgesic efficacy to epidural analgesia but fewer side effects. Systemic analgesics used to supplement a multimodal technique improve pain relief to the surgical wound and are reasonably effective in treating shoulder pain. Preventive analgesia aims to reduce sensitization; perioperative gabapentinoids and ketamine provide potentially useful short- and long-term benefits.Following sternotomy and cardiac surgery short-term intravenous opioid therapy is most commonly employed but non-opioid analgesics should be used in addition. NSAIDs should be used with caution. Epidural analgesia is uncommon. Other regional techniques such as parasternal local anaesthetic infiltration may reduce opioid requirements.

Access to the complete content on Oxford Medicine Online requires a subscription or purchase. Public users are able to search the site and view the abstracts for each book and chapter without a subscription.

Please subscribe or login to access full text content.

If you have purchased a print title that contains an access token, please see the token for information about how to register your code.

For questions on access or troubleshooting, please check our FAQs, and if you can't find the answer there, please contact us.