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Pain relief after thoracic and cardiac surgery 

Pain relief after thoracic and cardiac surgery
Pain relief after thoracic and cardiac surgery

Desmond P. McGlade

and David A. Scott

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date: 26 September 2020

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.

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