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Post-Thoracotomy Multimodal Analgesia — FRCA Final MCQ

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ModeratePain MedicinePost-Thoracotomy Multimodal AnalgesiaFRCA Final

A 62-year-old man (ASA III) with COPD undergoes a right upper lobectomy via thoracotomy. A right-sided thoracic epidural was placed at T5/6. Post-operatively on day 1, despite the epidural running at 8 mL/hr, he is unable to cough effectively and his pain score is 3/10 at rest but 8/10 on coughing. What is the most appropriate adjustment?

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Correct answer: D — Add IV paracetamol and NSAID as multimodal analgesia

This patient has adequate resting analgesia (3/10) but dynamic pain (coughing) of 8/10. Before increasing the epidural rate (which increases motor block and hypotension risk), multimodal analgesia should be optimised: regular IV paracetamol (1g QDS) and an NSAID (unless contraindicated) should be added. This is the core principle of enhanced recovery after thoracic surgery – multimodal analgesia reduces epidural requirements and side effects while improving overall pain control, particularly dynamic pain important for chest physiotherapy.

Reference: RCOA – 2023 – Acute pain management; ERAS Society – 2019 – Enhanced recovery after thoracic surgery