Evidence map›Paper›PMID 41521792›Full record

SynthesisAnaesthesia2026

Pain management after open thoracotomy 2025: procedure-specific postoperative pain management (PROSPECT) recommendations.

Adrien Lemoine, Anna Alber, Girish P Joshi, Marc Van de Velde, Geertrui Dewinter, Esther Pogatzki-Zahn, Marie-Pierre Bonnet, PROSPECT Working Group of the European Society of Regional Anaesthesia and Pain Therapy

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Anaesthesia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Erector spinae plane block.BJA education · 2026
    Review
  3. ARDS management in trauma patients.Intensive care medicine · 2026
    Review
  4. Review
  5. Article
  6. Article
  7. Article
  8. Article
  9. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Adrien LemoineDepartment of Anaesthesia, Intensive Care and Pain Management, Oscar Lambret Centre, Lille, France.
Anna AlberDepartment of Anaesthesia, Intensive Care and Peri-operative Medicine, Tenon Hospital, Paris, France.
Girish P JoshiDepartment of Anaesthesia and Pain Management, University of Texas Southwestern Medical Centre, Dallas, TX, USA.
Marc Van de VeldeUniversity of Leuven, Biomedical Sciences Group, Department of Cardiovascular Sciences, University Hospitals of Leuven, Department of Anaesthesiology, Leuven, Belgium.
Geertrui DewinterUniversity of Leuven, Biomedical Sciences Group, Department of Cardiovascular Sciences, University Hospitals of Leuven, Department of Anaesthesiology, Leuven, Belgium.
Esther Pogatzki-ZahnDepartment of Anaesthesiology Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany.
Marie-Pierre BonnetSorbonne University, Department of Anaesthesiology and Critical Care Medicine, Armand Trousseau Hospital, Paris, France.ORCID 0000-0003-2055-8813
PROSPECT Working Group of the European Society of Regional Anaesthesia and Pain Therapy

Funding

European Society of Regional Anaesthesia and Pain Therapy
6 · The paper itself

Abstract

introductionAdequate postoperative pain control is crucial for rehabilitation after open thoracotomy. The aim of this systematic review was to update the previous procedure-specific postoperative pain management recommendations for patients undergoing open thoracotomy.

methodsUsing previously reported PROSPECT methodology, we performed a systematic review of randomised controlled trials, systematic reviews and meta-analyses evaluating pain interventions for open thoracotomy published between 2015 and 2024. Data extracted from the included studies were evaluated by an expert subgroup that considered the relevance of the studied interventions in clinical practice and their risk/benefit profile. Recommendations were finalised after review and comments by all members of the PROSPECT working group using a modified Delphi approach. The Cochrane Risk of bias tool 2 was used to grade the quality of evidence.

resultsOverall, 100 studies were included. Based on the available evidence, either thoracic epidural analgesia or paravertebral blockade should be provided as a first-line analgesic intervention for open thoracotomy. Erector spinae plane, rhomboid intercostal or intercostal nerve blockade could be used as a second-line regional analgesia intervention. In addition, patients should receive basic analgesia consisting of paracetamol and non-steroidal anti-inflammatory drugs or cyclo-oxygenase-2 selective inhibitors. Acupuncture or cryoanalgesia is recommended when regional analgesia cannot be performed, albeit with a low level of supportive evidence. The choice of surgical technique, postoperative physiotherapy and approach to patient education should be based on outcomes other than pain control. DISCUSSION: In these updated guidelines on pain management after open thoracotomy, the main changes concern the recommendation of either thoracic epidural analgesia or paravertebral blockade as the first-line intervention according to patient and clinician preference, combined with basic systemic analgesia. The use of other regional blocks should be limited to patients who cannot receive thoracic epidural analgesia or paravertebral blockade.

Indexed as

Pain ManagementPostoperative PainThoracotomyHumansNerve BlockRandomized Controlled Trials as Topicpainpostoperativeregionalthoracotomy

Identifiers

PMID41521792
PMCPMC12973352

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.