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• W3021520579 abstract "Despite advances in open thoracotomy and video-assisted thoracic surgery techniques, pain control continues to be a major focus of postoperative thoracic surgical patient care. This fact is especially true now, given the ever-increasing pressure to shorten length of hospital stay and time from work. The options for post-thoracotomy pain management are generally well known. They include local nerve blocks, numerous regional techniques (many continuous), patient-controlled narcotics (given orally, by injection, or by using intravenous patient-care delivery systems), and non-narcotic, anti-inflammatory medications. Establishment of a highly effective and universally accepted approach to post-thoracotomy pain management has not yet been accomplished. The manner in which post-thoracic surgical pain is managed varies widely between institutions. Some use single pain control methods, others utilize combination approaches. Others embrace the principles of pre-emptive pain control before the onset of surgical trauma. Rarely are these local, institutional-based methods challenged or changed.The goal of an ideal post-thoracotomy pain regimen would be to provide effective, focused, patient-controlled or continuous pain relief with a minimum of local or systemic side effects. The only way to determine what the ideal pain regimen should be is for more institutions to develop prospective clinical trials to compare the effectiveness of the currently available pain management techniques.The study by Marret and colleagues is noteworthy for being a prospective, randomized clinical trial comparing different post-thoracotomy pain control methods, and for using a combination regional and systemic technique that fulfils many of the criteria for an ideal pain control regimen. As with many good studies, as some questions are answered others are raised. Can the paravertebral catheter be placed at the time of open thoracotomy by the thoracic surgeon? Is this regional method good enough to be used without systemic narcotics? How will this approach compare with epidural regional pain control methods? Hopefully the authors are planning additional prospective studies to address these questions.A high volume of thoracic surgery is performed across the country and worldwide. A greater effort should be made to establish a series of clinical trials to systematically and prospectively evaluate post-thoracotomy pain control methods in order to scientifically determine the ideal pain control approach. Despite advances in open thoracotomy and video-assisted thoracic surgery techniques, pain control continues to be a major focus of postoperative thoracic surgical patient care. This fact is especially true now, given the ever-increasing pressure to shorten length of hospital stay and time from work. The options for post-thoracotomy pain management are generally well known. They include local nerve blocks, numerous regional techniques (many continuous), patient-controlled narcotics (given orally, by injection, or by using intravenous patient-care delivery systems), and non-narcotic, anti-inflammatory medications. Establishment of a highly effective and universally accepted approach to post-thoracotomy pain management has not yet been accomplished. The manner in which post-thoracic surgical pain is managed varies widely between institutions. Some use single pain control methods, others utilize combination approaches. Others embrace the principles of pre-emptive pain control before the onset of surgical trauma. Rarely are these local, institutional-based methods challenged or changed. The goal of an ideal post-thoracotomy pain regimen would be to provide effective, focused, patient-controlled or continuous pain relief with a minimum of local or systemic side effects. The only way to determine what the ideal pain regimen should be is for more institutions to develop prospective clinical trials to compare the effectiveness of the currently available pain management techniques. The study by Marret and colleagues is noteworthy for being a prospective, randomized clinical trial comparing different post-thoracotomy pain control methods, and for using a combination regional and systemic technique that fulfils many of the criteria for an ideal pain control regimen. As with many good studies, as some questions are answered others are raised. Can the paravertebral catheter be placed at the time of open thoracotomy by the thoracic surgeon? Is this regional method good enough to be used without systemic narcotics? How will this approach compare with epidural regional pain control methods? Hopefully the authors are planning additional prospective studies to address these questions. A high volume of thoracic surgery is performed across the country and worldwide. A greater effort should be made to establish a series of clinical trials to systematically and prospectively evaluate post-thoracotomy pain control methods in order to scientifically determine the ideal pain control approach." @default.
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• W3021520579 date "2005-06-01" @default.
• W3021520579 modified "2023-10-18" @default.
• W3021520579 title "Invited commentary" @default.
• W3021520579 doi "https://doi.org/10.1016/j.athoracsur.2004.08.004" @default.
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