Background: Post-thoracotomy pain syndrome (PTPS) is reported with a prevalence ranging between 33% and 91% in literature. However, the difference between open (TT) and video-assisted thoracic surgery (VATS) concerning the prevalence and neuropathic character of PTPS has not yet been systematically investigated. Furthermore, knowledge on analgesic treatment and its efficacy is limited.
Methods: Structured telephone interviews were conducted with 488 patients 6 to 30 months after TT and VATS. In case of pain, patients received a structured questionnaire including the Leeds Assessment of Neuropathic Symptoms and Signs and Brief Pain Inventory.
Results: Prevalence of PTPS was 28.6%. 13.2% of patients had a pain intensity Numeric Rating Scale >3, and 4.6% of patients had a pain intensity Numeric Rating Scale >5. In case of PTPS, 63% of patients suffered from neuropathic pain. Post-thoracotomy pain syndrome was more frequent after TT than after VATS (38.0% vs 29.3%, < 0.05) and in patients younger than 65 years (42.3% vs 26.4%; < 0.05). TT resulted more often in neuropathic pain (67.7% vs 43.9%; < 0.05). Forty six percent of PTPS patients received analgesics: 30.3% nonopioids, 25.2% opioids, 10.9% anticonvulsants, and 1.7% antidepressants. Antineuropathic agents were used in 17.4% of patients with neuropathic pain. In 36.7% of patients, the reported reduction of pain was less than 30.0%.
Conclusions: Post-thoracotomy pain syndrome is not as common as estimated. In most cases, pain intensity is moderate, but patients suffering from severe pain require special attention. They are often heavily disabled due to pain. Tissue-protecting surgery like VATS is beneficial for the prevention of PTPS. Analgesic medications are often underdosed, unspecific for neuropathic pain, and insufficient.
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http://dx.doi.org/10.1097/PR9.0000000000000810 | DOI Listing |
J Thorac Dis
December 2024
Department of Anaesthesiology, Critical Care and Pain Medicine, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany.
Background: Moderate to severe postoperative pain is common among patients following thoracotomy and serves as a risk factor for developing chronic post-thoracotomy pain (CPTP). This randomized controlled trial evaluated the effects of pre-emptively administered ketamine compared to placebo and standard care on both acute postoperative pain and CPTP.
Methods: Two hundred patients were enrolled in this prospective, randomized trial.
Ann Med
December 2025
Department of Anesthesiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan Province, China.
Background: Chronic post-thoracotomy pain (CPTP) is characterized by high incidence, long duration, and severity of pain. Medial prefrontal cortex (mPFC) is a brain region closely associated with chronic pain, and norepinephrine is involved in pain regulation. But the role of mPFC norepinephrine in CPTP and its possible mechanism is unclear.
View Article and Find Full Text PDFInt J Clin Pharm
January 2025
Department of Anesthesiology, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei Economic and Technological Development District, Hefei, Anhui, China.
Background: The analgesic efficacy of esketamine combined with butorphanol in thoracoscopic surgery remains unclear.
Aim: This study explored the effects of perioperative esketamine combined with butorphanol versus butorphanol alone on acute and chronic postoperative pain in patients who underwent video-assisted lobectomy.
Method: A total of 181 patients were enrolled, with 90 in the esketamine-butorphanol group (Group BK) receiving intraoperative esketamine infusion and postoperative patient-controlled intravenous analgesia (PCIA) (esketamine 1.
BMJ Open
December 2024
Department of Anesthesiology, Henan Provincial Chest Hospital & Chest Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Introduction: Chronic post-thoracotomy pain (CPTP) is a persistent and disabling condition affecting a significant proportion of patients after thoracotomy and posing a challenge for clinicians, despite advances in surgical and pain management strategies. Esketamine, the S-enantiomer of ketamine, has emerged as a promising therapeutic agent for various pain conditions, with evidence for its effectiveness in alleviating acute and chronic pain. This systematic review and meta-analysis will be conducted to assess the efficacy of esketamine in treating CPTP, and evaluate its effectiveness in reducing pain intensity, improving functional outcomes, and reducing opioid consumption, as well as its adverse effects.
View Article and Find Full Text PDFIndian J Thorac Cardiovasc Surg
January 2025
Department of Thoracic Surgery, University of Health Sciences, Konya City Hospital, 135/1, Adana Ring Road, Akabe, Karatay, Konya, Turkey.
Objective: Transcutaneous electrical nerve stimulation (TENS) has been applied to alleviate post-thoracotomy pain. In this study, we investigated the effects of TENS on pain scores, additional opioid doses, opioid-related side effects, and potential respiratory and cardiac complications.
Method: In this controlled, randomized study, 40 patients underwent muscle-sparing thoracotomy.
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