regional analgesia for thoracic surgery

local anaesthetic pain management regional analgesia regional block regionalanaesthesia Aug 10, 2026

Thoracic surgery can bring significant postoperative pain, and that pain matters. When pain is poorly controlled, patients may find deep breathing, coughing and mobilisation more difficult, potentially affecting recovery. For perianaesthesia nurses, understanding the analgesic plan helps us recognise what the patient needs before pain becomes difficult to manage.

Regional analgesia is an important part of a multimodal approach. For open thoracotomy, current PROSPECT recommendations identify either thoracic epidural analgesia or paravertebral blockade as first-line regional techniques. Erector spinae plane, rhomboid intercostal or intercostal nerve blocks may be considered when these options are not used.

Depending on the surgical approach and local practice, an extrapleural catheter may also be used to provide ongoing local anaesthetic analgesia. This is another situation where understanding what the patient has received, how the infusion is prescribed and whether the analgesia is achieving its intended effect becomes important.

For video-assisted thoracoscopic surgery, the approach is less invasive, but pain can still be significant. Paravertebral and erector spinae plane blocks are recommended options, with serratus anterior plane block as a second choice.

🔹 Look beyond the pain score. Pain with coughing, deep breathing and movement can be particularly important after thoracic surgery.

🔹 Know the analgesic technique. Whether the patient has an epidural, paravertebral block or an extrapleural catheter, understand what has been inserted and what is being infused.

🔹 Think multimodal. Regional analgesia sits alongside basic analgesia such as paracetamol and an NSAID or COX-2-selective inhibitor when appropriate.

🔹 Assess the whole patient. Pain, sedation, respiratory function and the ability to cough, breathe deeply and mobilise all help tell us whether the analgesic plan is working.

Good analgesia is not simply about making a pain score smaller. It is about helping the patient breathe, move and recover with greater comfort and confidence.

Clinical takeaway: Regional and catheter-based analgesic techniques can be valuable components of a planned multimodal strategy after thoracic surgery. Knowing the technique, monitoring its effects and connecting pain assessment with respiratory and functional recovery are key parts of safe perianaesthesia care.

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References

Lemoine, A., Alber, A., Joshi, G.P., Van de Velde, M., Dewinter, G., Pogatzki-Zahn, E. and Bonnet, M-P. (2026). Pain management after open thoracotomy 2025: procedure-specific postoperative pain management (PROSPECT) recommendations. Anaesthesia, 81, 541–555.

Feray, S., Lubach, J., Joshi, G.P., Bonnet, F. and Van de Velde, M. (2022). PROSPECT guidelines for video-assisted thoracoscopic surgery: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia, 77, 311–325.

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