Will it hurt?

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Although a thoracotomy is inherently a very painful incision, modern techniques of pain management allow surgeons to relieve most of the pain following surgery. Using a combination of three techniques,

• intravenous morphine, given by both constant drip and by patient controlled analgesia (PCA),
• continuous infustion paravertebral block with 1% lidocaine and
• intramuscular or intravenous ketorolac,

pain can be kept to an average pain score of 3 out of 10 by a verbal analog pain score, in which the patient reports his level of pain with 0=no pain and 10=severe pain.

This is not only important from the standpoint of patient comfort. It also reduces the incidence of many of the complications of surgery, since it is important for the patient to be able to deep breath and cough to avoid the development of collapse of the lung and pneumonia.

Another effective system of pain control is called epidural anesthesia, and involves placement of a catheter through a needle into the space surrounding the spinal cord and infusing narcotics and local anesthetics after surgery.

Intermittent injections of narcotics on request (PRN) of the patient is the traditional method of post-operative pain control, but does not produce acceptable pain relief.

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