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The hemiclamshell incision is a valid
but infrequent surgical alternative for the resection of tumors from
mediastinum. This point makes this approach impossible to be studied under a
randomized controlled trial. The triple association of thoracotomy, sternotomy
and cervicothomy makes the hemiclamshell approach a high intensity
postoperative pain surgery.
However, there is no published data on this topic, and the reviewed articles
only mention the analgesic regimens as a secondary point. Indeed, no author
defines the best epidural drugs mixture for the patients. Multimodal analgesic regimen based on
regional anesthesia should be used. Based on the recent advances on spinal
opioids, morphine could be a good choice as epidural coadjutant to local
anesthetics for hemiclamshell incision.