A New Standard for Post-Thoracotomy Pain: Updated PROSPECT Guidelines
A major systematic review has updated the procedure-specific postoperative pain management (PROSPECT) recommendations for open thoracotomy, a critical procedure in cardiothoracic and thoracic surgical oncology. The 2025 guidelines, published in *Anaesthesia*, consolidate evidence from 100 randomized controlled trials and meta-analyses. The key development is the elevation of thoracic paravertebral blockade to a first-line analgesic option alongside thoracic epidural analgesia, offering surgeons and anesthesiologists equivalent choices based on patient factors and clinical preference. The protocol mandates this regional analgesia be combined with foundational systemic pain control using paracetamol and NSAIDs or COX-2 inhibitors. For patients where first-line blocks are contraindicated, second-line interventions like erector spinae plane blocks are recommended, while techniques like cryoanalgesia are suggested only when regional methods are entirely unfeasible.
Study Significance: These evidence-based guidelines directly refine perioperative care pathways for a common major surgery, impacting enhanced recovery protocols and surgical outcomes. For the surgical team, it provides a clear, hierarchical framework for multimodal pain management, potentially reducing reliance on opioids and mitigating postoperative complications. This update empowers decision-making in preoperative assessment and intraoperative planning, ensuring optimal pain control to facilitate critical post-surgical rehabilitation.
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