Other measures to reduce pain on thoracic procedures

There are a number of other techniques which can be used to reduce pain.  The most popular of these is the use of thoracoscopy.  Thoracoscopy does not involve the prolonged pressure on the intercostal nerves that is found when one uses the thoracotomy rib spreader.  One does have to be careful of torqueing instruments against intercostal nerves in tight port spaces. 

The technique of spreading the ribs is also important.  Any measure to reduce the amount of spreading is likely to help. There is also evidence that spreading the ribs slowly reduces the amount of pressure actually applied to the intercostal nerves at the beginning of the case. 

It is probable that smaller chest drains reduce abrasion against intercostal nerves and potentially can reduce pain.  However this has not been mildly demonstrated and one must be aware that inadequate drains can lead to complications which in the long run increase discomfort.  The appropriate use of non steroidal anti inflammatory drugs (often covered by a proton pump inhibitor), Paracetamol and other non narcotic analgesia techniques can reduce postoperative pain.  These techniques can reduce the opioid requirement or reduce the epidural requirement.