Pain Relief Methods after Thoracotomy

Background: Thoracotomy is one of the surgical operations which causes severe pain. In fact, this pain is one of the most excruciating pains caused by surgical operations. Different procedures are performed to decrease this pain which is associated with significant physiologic, mental and pathologic complications. Each of these procedures has its own advantage and disadvantages. In many centers, the most common treatment method used, is considered as the first choice. In this study, common methods of analgesia after thoracotomy were compared. Materials and Methods: During this meta-analysis, “Visual Analogue Scale” (VAS) of patients in epidural group was compared with those in four groups of systemic opioids , intercostal block, paravertebral block and intrapleural infusion in the first 24 hours after surgery. Data obtained from 28 randomized clinical trials (RCT) which compared the procedures in 1697 patients after thoracotomy were gathered using random effect model, effect size index and the standardized difference average. Statistical values were evaluated and the results obtained using standard error, 5% maximum confidence limit and 5% minimum confidence limit. The obtained data were evaluated using studies performed between 1987 and 2005. After evaluating 314 titles and 185 abstracts, 28 articles were entered in the metaanalysis considering inclusion criteria. Four groups of epidural with systemic opioids, epidural with para-vertebral, epidural with intercostal and epidural with intrapleural analgesia were studied. Results: It was noticed that the epidural method in total 24 hours with 95% CI= -0.9802 to -0.3844 was a better procedure compared with systemic opioids. Epidural method did not show any difference with intercostal method in 24 hours mean with 95% CI= -0.2171 to +0.5906. Epidural method was also better than intrapleural in 24 hours mean with 95% CI= -1.1166 to 0.0106. When comparing epidural with para-vertebral, epidural was better with 95% CI= +0.1744 to -0.4527. Conclusion: According to the evaluations performed, epidural method is recommended as the method of choice to reduce pain after thoracotomy. (Tanaffos 2005; 4(16): 29-39)