Analgesic management after thoracoscopic surgery: recent studies and our experience

Thoracoscopic surgery (TS) is a less invasive procedure than open thoracotomy because it involves less postoperative pain, a lower complication rate, a shorter time to ambulation, and shorter hospitalization. Clinically, patients who undergo TS do not always harbor mild-to-moderate postoperative pain. Additionally, the insufficient management of postoperative pain might lead to the development of chronic pain. We previously reported that individual pain scores after TS are classified as no and mild (0–3/10), moderate (4–6/10), and severe (7–10/10) using the numerous rating scale (NRS). In an analysis of 524 patients who underwent TS, the incidence of mild pain was 87.0% on the operative day and 75.6% during ambulation (1). The mean NRS score after TS in patients who received a single-shot intercostal nerve block (INB) using ropivacaine was 1.83±1.49 on the operative day, 2.73±1.75 during ambulation, and 1.87±1.33 during settling, after receiving several analgesic drugs after TS, whereas the mean NRS score was 3.05±1.51 during ambulation after open thoracotomy in patients who received paravertebral block (PVB) or epidural analgesia (EA); thus, pain scores were significantly higher after open thoracotomy than TS (P<0.01) (1)