Supervisors info:
Μπίρμπας Κωνσταντίνος, Καθηγητής, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Κακλαμάνος Ιωάννης, Καθηγητής, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Μαριόλης Σαψάκος Θεόδωρος, Καθηγητής, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Summary:
Introduction: Pain is a multifaceted and multifactorial phenomenon. With the development of science, various tools and methods have been developed to quantify and manage postoperative pain. Effective postoperative pain treatment is an integral part of the perioperative care of patients, as it contributes significantly to the reduction of postoperative complications. Thoracic operations are considered among the most painful surgical operations. Many analgesic techniques have been described for the relief of postoperative pain after thoracotomy.
Aim: In this study, the main methods of thoracotomy analgesic treatments and pain measurement tools are referenced. In addition, a systematic review of studies referencing the treatment of postoperative pain after thoracotomy is carried out, with the aim of analyzing the results and reporting the most important findings.
Methodology: The literature used for this study was retrieved through the online databases Pubmed, GoogleScholar and Scopus. Selection criteria for the included studies were the period of publication of the studies must be within the last 15 years (2008-2023), the publications to be in English or Greek language, the publications to be primary type research, the publications to study the postoperative pain manaegment in patients undergoing thoracotomy and access to the full article. Seventeen studies were included in the present review.
Results: Regarding intravenous analgesia, it appeared that the use of psychotropic drugs as an adjuvant to analgesic treatment contributes to the overall patient satisfaction and the reduction of reported pain levels and side effects, in contrast to the administration of ketamine, which had no significant benefit in terms of these factors. Moreover, the combination of ketorolac plus paracetamol seems to provide a slightly better analgesic effect than that of pethidine, when administered intravenously. In the case of thoracic epidural analgesia, the results showed that the addition of magnesium sulfate can significantly reduce the levels of postoperative pain and the need for opioids, without causing adverse effects. Most studies referencing cryoanalgesia seem to associate this method with an increased incidence of chronic neuropathic pain. They also report no statistically significant benefit of cryoanalgesia on acute pain levels. Compared to systemic analgesia, paravertebral anesthesia produces better results, with morphine being the ideal analgesic agent of choice. As for the preventive use of local anesthesia at the site of the surgical incision, it seems to be a safe, quick and simple procedure that achieves a reduction of adverse effects. Lastly, the use of propofol in general anesthesia has been associated with lower incidence of acute postoperative pain.
Conclusions: Currently, the multifactorial model of analgesia is the optimal way to treat postoperative pain after thoracotomy. A necessary condition for achieving this goal is the continuous and effective assessment of patients using the appropriate tools, as well as the continuous training of the entire group of health professionals, as pain constitutes an always relevant problem.
Keywords:
Pain management, Thoracotomy, Postoperative pain, Analgesia
