Postoperative Schmerzsyndrome nach Thorakoskopien und Thorakotomien – Prävention und Behandlung

Background: Despite minimally invasive techniques, chronic pain after thoracic surgery - often referred to as post-thoracoscopy/post-thoracotomy pain syndrome (PTPS) - remains an important clinical challenge. Methods: This narrative review summarises current evidence on the epidemiology, pathophysiology, prevention and treatment of chronic postoperative pain (CPSP) following thoracic surgical procedures. The focus is placed on analgesic strategies in the context of early mobilisation and fast-track concepts. Results: Acute postoperative pain is the most important predictor of pain chronification. Multimodal analgesia with paracetamol, NSAIDs/COX-2 inhibitors and opioid-sparing adjuncts form the basis of therapy. In thoracotomy, thoracic epidural analgesia (TEA) and paravertebral blockade provide the most reliable results. In thoracoscopy, single-shot techniques combined with multimodal analgesia are often sufficient, while catheter-based techniques offer advantages in high-risk patients or more extensive procedures. Alternative approaches, such as surgically placed intercostal catheters, may be pragmatic adjuncts. Conclusion: Prevention of chronic pain after thoracic surgery is primarily achieved through adequate acute pain management. Continuous regional techniques are crucial for early mobilisation and fast-track protocols, while established PTPS/CPSP requires a multimodal and interdisciplinary treatment.