A Literature Review of Methods of Perioperative Pain Management in Thoracic Outlet Decompression

Abstract

Objectives: Post-operative pain control in thoracic outlet decompression (TOD) is difficult due to the complex innervation of the anatomical region. Poor post-operative pain control has been associated with worse patient experiences and prolonged inpatient stays. This study aims to identify evidence-based peri-operative analgesic strategies for thoracic outlet decompression.

Methods: MEDLINE and Embase searches were performed to identify literature assessing peri-operative pain control methods in patients undergoing TOD. Studies were limited to the English language and within 10 years of publication. Abstracts were screened for relevance by two reviewers and identified review articles on thoracic outlet decompression were also included for critical appraisal.

Results: The primary literature search yielded 124 studies whose abstracts were screened resulting in a total of 16 studies being included for full review and critical appraisal. This included 1 randomised control trial, 7 retrospective cohort studies, 1 case series study, 2 case report study and 5 review articles. Studies utilised a baseline of multimodal oral analgesics with their main investigative focus centred on the use of different methods of peripheral nerve blockade.

Conclusion: There is only 1 published randomised controlled trial study investigating postoperative analgesic modalities in thoracic outlet decompression. This deficit of evidence was reflected in the high variation of pain management strategies employed in the published literature. Evidence should be sought to assess the relative efficacy of the various pain management strategies.

Keywords: Thoracic outlet decompression; analgesia; nerve block; pain management; thoracic outlet syndrome.