Author(s): ,
Lan-Pak-Kee, V.
Barts Health NHS Trust, Anaesthetics, London, United Kingdom
Tarrell, T.
Barts NHS Trust, Anaesthetics, London, United Kingdom
Egan, T.*
Barts Health NHS Trust, Anaesthetics, London, United Kingdom
Konig, T.
Barts Health NHS Trust, Surgery, London, United Kingdom
ESRA Academy. Egan T. Sep 13, 2017; 190695; 190 Topic: Thoracic Surgery - Analgesia after Thoracotomy - Cardiac Surgery- Vascular Surgery
Dr. Timothy Egan
Dr. Timothy Egan

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Background and Aims:

Emergency clamshell thoracotomy for a variety of indications in major trauma is an increasingly commonly performed procedure. Survivors present an analgesic challenge as the gold standard of thoracic epidural is rarely suitable in this patient group. Pain related morbidity is high, potentially delaying discharge from intensive care and from hospital. Local anaesthetic wound infusions via elastomeric pumps have been shown to be a useful adjunct to a multimodal analgesic strategy for many types of surgery, avoiding many of the problems associated with neuraxial blockade and systemic opiates. 


We report on the novel and successful use of local anaesthetic infusion via elastomeric pump in a 17-year-old man who underwent emergent clamshell thoracotomy after sustaining a stab wound to the flank. 




Continuous local anaesthetic infusion via wound catheter has been shown to significantly reduce post-operative patient pain scores and decrease length of hospital stay, whilst sparing opioid use. It is technically simpler and avoids many potentially serious side effects associated with other regional analgesia techniques. 

This is the first reported case of its application post clamshell thoracotomy for trauma. We believe that this technique could significantly reduce pain-related morbidity and improve the patient experience in those undergoing clamshell thoracotomy following trauma.

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