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Optimizing Recovery After Thoracotomy: Evidence-Based Non-Opioid and Multimodal Analgesia - A Narrative Review.

Shahroz Ali1, Fatima Sohail2, Fatima Fazal3

  • 1Medicine, The Aga Khan University Hospital, Stadium Road, Karachi, P.O. Box 3500, 74800, Pakistan.

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Opioid-free pain management after thoracic surgery is achievable using multimodal strategies. These approaches combine local anesthetics, non-opioid medications, and physical therapies to enhance recovery and reduce chronic pain.

Keywords:
ERASMultimodal analgesiaNon-opioid analgesiaPain managementPost-thoracotomy painRegional anaesthesiaThoracic surgery

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Area of Science:

  • Thoracic Surgery
  • Pain Management
  • Anesthesiology

Background:

  • Post-thoracotomy pain affects nearly half of patients, leading to complications like respiratory issues and delayed rehabilitation.
  • Opioids are the primary analgesics but have significant side effects, including dependency and respiratory impairment.

Purpose of the Study:

  • To review current opioid-free strategies for maximizing recovery after thoracotomy.
  • To highlight effective non-opioid and non-pharmacologic interventions for postoperative pain management.

Main Methods:

  • Narrative review of recent studies on opioid-free pain management.
  • Inclusion of local anesthetic techniques (epidural, paravertebral, erector spinae plane blocks).
  • Evaluation of non-opioid pharmaceutical agents (acetaminophen, NSAIDs, gabapentinoids, ketamine, steroids, lidocaine).

Main Results:

  • Local anesthetic techniques and non-opioid medications are effective in managing post-thoracotomy pain.
  • Non-pharmacologic interventions like physical and respiratory therapy complement analgesic strategies.
  • Enhanced Recovery After Surgery (ERAS) pathways integrate these methods for improved outcomes.

Conclusions:

  • Multidisciplinary, opioid-sparing analgesic protocols can optimize postoperative recovery.
  • These strategies may reduce the incidence of chronic post-thoracotomy pain.
  • Integrating ERAS pathways is crucial for successful opioid-free pain management.