Neurol. praxi. 2014;15(2):92-96

Risks for creation of neuropathic post-thoracotomy pain

MUDr. Jan Procházka, Ph.D.^1,2, MUDr. Vilém Malý³

¹ Oddělení intenzivní medicíny, KZ a.s., Masarykova nemocnice, o. z., Ústí nad Labem

² Ambulance bolesti Neurochirurgické kliniky UJEP, KZ a.s., Masarykova nemocnice, o. z., Ústí nad Labem

³ Oddělení hrudní chirurgie, KZ a.s., Masarykova nemocnice, o. z., Ústí nad Labem

Chronic post-thoracotomic pain is a serious problem in thoracic surgery, especially when accompanied with a neuropathic component. Neuropathic post-thoracotomic pain is usually based on intercostal nerve injury with subsequent central sensitization. This disorder is affected by several pre-operative, operative and post-operative factors, among them the most significant are the type and extent of surgical procedure and the mode of post-operative analgesia. Minimizing rib distractions during surgery and a multimodal pre-emptive analgesia employing thoracic continuous epidural analgesia and non-opioid analgesics are considered to be the most effective means of prevention. If a neuropathic post-thoracotomic pain occurs, its therapy is based on guidelines for peripheral neuropathic pain using antidepressants, gabapentin/pregabalin and opioids. Topical treatment can involve 8 % capsaicin, too. Performing a surgery in a thoughtful way and providing multimodal perioperative analgesia can significantly diminish the occurrence of neuropathic post-thoracotomy pain.

Keywords: thoracotomy, neuropatic pain, multimodal pre-emptive analgesia, thoracic epidural analgesia

Published: May 10, 2014  Show citation