One of the most severe types of postoperative pain is following a thoracotomy. Presence of inadequate analgesia usually results in inability to breathe deeply and cough forcefully, both of which hamper postoperative pulmonary rehabilitation with subsequent retention of secretions, atelectasis and pneumonia¹. Analgesic techniques such as Intercostal, paravertebral, interpleural and thoracic epidurals with local anesthetic and opioids have been employed for pain relief.² Thoracic epidural analgesia (TEA) is by far the best option of relieving pain following a thoracotomy, especially with low concentration of local anesthetic and a lipophilic opioid.³ Neuropathic pain following thoracotomy, known as post thoracotomy pain is common , sometimes severe enough to incapacitate and often becomes chronic.^4,5Post-thoracotomy pain syndrome or PTPS (chronic post-thoracotomy pain or post-thoracotomy neuralgia) is defined by the International Association for the Study of Pain (IASP) as ‘pain that recurs or persists along a thoracotomy incision at least two months following the surgical procedure’. In general, it is burning and stabbing pain with dysesthesia and thus shares many features of neuropathic pain⁶. Over the years there has been a gradual shift towards minimally invasive or thoracoscopic or VATS (video assisted thoracoscopic surgery) approach. This approach has shown early and better recovery with early discharge from the hospital.⁷ Despite being less invasive, VATS procedures have not had a favourable impact on pain as was anticipated.⁸ They too present with similar pain and sometimes even after discharge, and have been reported to be of neuropathic nature.^9,10 The incidence of Chronic Post surgical pain^11,12 following VATS approach has been reported in the range of 20-47%.

Grosen et al¹³, reported sensory changes in the painful area in 62% patients with post thoracotomy pain syndrome.  Simultaneous occurrence of pain and sensory disturbances caused by nerve injury is one of the mechanisms believed to cause PTPS.¹⁴ However, it has been noticed that, sensory disturbances are not always associated with pain¹⁵.

At Tata Memorial Hospital, over the last 10 years there has been as steady shift towards minimally invasive VATS approach for thoracic surgeries. A thoracic epidural catheterization, which is an important aspect for providing analgesia for thoracotomy, is seldom employed in those undergoing VATS approach. The trend is to use IV opioids intraoperatively along with NSAIDS (if not contraindicated) & Paracetamol along with IV PCA (Patient controlled analgesia) postoperatively.

The purpose of the study is to determine the incidence, nature and severity of persistent pain if any at 3 and 6 months following thoracic surgery with intercostal incisions 

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