Post-thoracotomy pain syndrome or PTPS (chronic post-thoracotomy pain or post-thoracotomy neuralgia) is defined by the International Association for the Study of Pain (IASP) as ‘pain that recurs or persists along a thoracotomy incision at least two months following the surgical procedure’.
Over 75% of thoracotomy patients report constant severe ache in the ipsilateral shoulder post-surgery (55). This pain is relatively resistant to intravenous opioids and is only partially relieved by NSAIDs. Postulated mechanisms include transection of a major bronchus, ligamentous strain from malposition or surgical mobilization of the scapula, pleural irritation due to the thoracostomy tube, or referred pain from irritation of the pericardium or mediastinal and diaphragmatic pleural surfaces.
NSAIDS
Intercostal Nerve Block
Epidural Analgesia
Paraverebral Nerve Block
Preemptive Analgesia and Thoractomy
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