Optimising Postoperative Pain to Improve Recovery After Lung Cancer Resection: A Narrative Review of Surgical and Analgesic Strategies.

Surgical resection for lung cancer is the primary treatment modality for early-stage tumours, and there is likely to be an increase in the need for surgery with improvements in the early detection of lung cancer, as well as advances in thoracic surgery that allow patients who would have previously been deemed unsuitable to undergo surgical resection. Despite its potentially curative nature, the invasiveness of thoracic surgery, as well as potential concerns regarding postoperative pain and recovery, means that some patients may decline surgical resection of their lung cancer. Strategies to reduce postoperative pain may improve outcomes following lung resection and may allow more patients to undergo surgical treatment for lung cancer. This narrative review aims to highlight the importance of improving postoperative pain control and review the evidence for some of the surgical and analgesic strategies to achieve this. Modifications to the traditional thoracotomy technique and increased adoption of minimally invasive approaches are some of the surgical strategies that may improve postoperative pain control and recovery. Analgesic strategy may play an even more important role in optimising recovery following thoracic surgery. While opiate medication has been the mainstay of postoperative pain management, there is increasing recognition of opiate-related complications and addiction. Regional anaesthetic techniques are playing a more prominent role in analgesic strategies post-thoracic surgery. Thoracic epidural has been considered the gold standard, but it is associated with its own complications. Newer regional anaesthetic techniques may be equally as effective as a thoracic epidural but with fewer complications. Further study is needed to elicit the optimal regional anaesthesia strategy. Certainly, a combined approach of improvements in surgical technique along with a multi-modal analgesia strategy incorporating regional anaesthetic techniques will yield the best outcomes with regard to reducing postoperative pain, avoiding complications and improving recovery for patients undergoing lung cancer resection.