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

Abstract

Postoperative pain control in thoracic outlet decompression (TOD) is difficult due to the complex innervation of the anatomical region. Poor postoperative pain control has been associated with worse patient experiences and prolonged inpatient stays. This study aims to identify evidence-based perioperative analgesic strategies for TOD. MEDLINE and Embase searches were performed to identify literature assessing perioperative 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 2 reviewers, and identified review articles on TOD were also included for critical appraisal. 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 randomized control trial, 7 retrospective cohort studies, 1 case series study, 2 case report study, and 5 review articles. Studies utilized a baseline of multimodal oral analgesics with their main investigative focus centered on the use of different methods of peripheral nerve blockade. There is only 1 published randomized controlled trial study investigating postoperative analgesic modalities in TOD. This deficit of evidence was reflected in the high variation of pain management strategies employed in the published literature.