Search

Background and Objective: Thoracic surgery causes significant pain which can negatively affect pulmonary function and increase risk of postoperative complications. Effective analgesia is important to reduce splinting and atelectasis. Systemic opioids and thoracic epidural analgesia (TEA) have been used for decades and are effective at treating acute post-thoracotomy pain, although both have risks and adverse effects. The advancement of thoracoscopic surgery, a focus on multimodal and opioid-sparing analgesics, and the development of ultrasound-guided regional anesthesia techniques have greatly expanded the options for acute pain management after thoracic surgery. Despite the expansion of surgical techniques and analgesic approaches, there is no clear optimal approach to pain management. This review aims to summarize the body of literature regarding systemic and regional anesthetic techniques for thoracic surgery in both thoracotomy and minimally invasive approaches, with a goal of providing a foundation for providers to make individualized decisions for patients depending on surgical approach and patient factors, and to discuss avenues for future research., Methods: We searched PubMed and Google Scholar databases from inception to May 2021 using the terms "thoracic surgery", "thoracic surgery AND pain management", "thoracic surgery AND analgesia", "thoracic surgery AND regional anesthesia", "thoracic surgery AND epidural". We considered articles written in English and available to the reader., Key Content and Findings: There is a wide variety of strategies for treating acute pain after thoracic surgery, including multimodal opioid and non-opioid systemic analgesics, regional anesthesia including TEA and paravertebral blocks (PVB), and a recent expansion in the use of novel fascial plane blocks especially for thoracoscopy. The body of literature on the effectiveness of different approaches for thoracotomy and thoracoscopy is a rapidly expanding field and area of active debate., Conclusions: The optimal analgesic approach for thoracic surgery may depend on patient factors, surgical factors, and institutional factors. Although TEA may provide optimal analgesia after thoracotomy, PVB and emerging fascial plane blocks may offer effective alternatives. A tailored approach using multimodal systemic therapies and regional anesthesia is important, and future studies comparing techniques are necessary to further investigate the optimal approach to improve patient outcomes., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-21-1740/coif). The authors have no conflicts of interest to declare., (2022 Journal of Thoracic Disease. All rights reserved.)

Objective: To discuss and summarize the literature for airway and anesthetic management tools the anesthesiologist can use for airway surgery to both successfully manage the patient's physiological needs and provide the surgeon the optimal surgical conditions with which to perform the surgery safely., Background: The airway and anesthetic management of patients presenting for thoracic surgery poses the anesthesiologist with a unique set of challenges, but also a unique set of opportunities to artfully utilize and adapt a variety of management options that has developed over several decades of innovation. Sixty years ago, airway surgery was initially performed with the patient spontaneously breathing and providing anesthesia with halogenated agents and airway topicalization. As medicine entered the latter half of the twentieth century with its development of new airway devices and modern anesthetic agents, most airway surgeries could be safely performed under general anesthesia with secured airways. Today, with continued technological advancements in surgical techniques and an expanding population of challenging patients, the application of nonintubated anesthetic techniques and extracorporeal support is on the rise., Methods: We conduct a narrative review of the literature on the history of airway and anesthetic management for thoracic surgery, the current management methods and evidence for each modality, and discuss future directions for the field., Conclusions: While the airway and anesthetic management for airway surgery is challenging, the anesthesiologist has a variety of options including cross-field ventilation, jet ventilation, nonintubated techniques, and extracorporeal support to safely care for the patient. Whichever methods are chosen for the patient and surgery, thoracic surgery remains uniquely positioned in its need for close sharing and collaboration of all airway and anesthetic management decisions between the anesthesiologist and the surgeon., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/tlcr-21-917). The authors have no conflicts of interest to declare., (2021 Translational Lung Cancer Research. All rights reserved.)