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Gharagozloo. Mini-invasive Surg 2020;4:8 I http://dx.doi.org/10.20517/2574-1225.2019.62 Page 11 of 13

Figure 6. On-Q catheters in place in the narrow subpleural tunnel

Table 1. Likert Pain Scores Median (Range), Subpleural local anesthetic (n = 243) vs. Epidural catheter supplemented by
narcotics (n = 238)
Day 1 Day 14 Day 30
Epidural 8 (4-9) 7 (5-9-8) 5 (1-5)
Subpleural Catheter 2 (1-3) 1 (1-3) 1 (0-1)
P < 0.001 P < 0.001 P < 0.001

CONCLUSION
A combined, multimodal approach appears to be the most effective one in dealing with analgesia in the
thoracic surgical patient. Any treatment modality needs to attempt to decrease the overall pain experience
by preventing sensitization at any time throughout the perioperative course. Thus, multimodal therapy
means focusing on addressing pain at the various sites. A multimodal program may embrace two or more
therapies. For example, use of neural blockade, whether by epidural or other nerve blocks, is combined
with systemic opioid administration (first intravenously, and then via oral route). In addition, NSAID use
such as ketorolac in either the preoperative or postoperative phase can also add to the multimodal effect.
Choice of a modality is dependent upon many factors, including surgeon preference, anesthesia preference,
institutional features or limitations, and personal success or failures with certain treatments. Regardless, a
comprehensive pain management regimen is essential for any robotic thoracic surgical program.

DECLARATIONS
Authors’ contributions
The author contributed solely to the article.

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
The author declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.