Table 1. Enhanced analgesia pathway for thoracic surgery.

Phase of care	Management options
Ensuring patient receives best plan for postoperative analgesia
Preoperative	Education:
	Manage expectations
	Analgesia options
	Continue prescribed analgesics
Admission	Preop meds:
	Acetaminophen
	NSAIDs
	Gabapentinoid
Ensuring patient has the best analgesic management during surgery
Intra-operative	Minimally invasive procedure if possible
	Minimize intraoperative opioids
	VATS:
	1. Intercostal block under direct vision (single level vs. multilevel) vs. other blocks, e.g., bupivacaine 0.25% + epi 1:400,000 (less than 2.5 mg/kg)
	2. Dexamethasone 4-8 mg in local solution or IV
	3. Ketamine (low dose)
	4. Ketorolac (if NSAID omitted preop)
	Thoracotomy:
	1. Epidural (LA, opioid, epinephrine)
	2. Paravertebral catheter (percutaneous vs. surgically placed)
	VATS convert to thoracotomy:
	1. Paravertebral catheter (surgically placed)
Ensuring patient experiences the best postoperative analgesia
Post-operative	Minimize opioids
	Early transition from intravenous to oral analgesics
	Regional catheter local anesthetics: (I) epidural; (II) paravertebral
	Multimodal analgesia:
	1. Acetaminophen (regular dosing)
	2. NSAID (regular dosing)
	3. Gabapentinoid (regular dosing)
	4. Tramadol prn
	5. Hydromorphone prn
Discharge	Plan in place in the event of poorly controlled analgesia
	Acetaminophen (regular dosing, define duration)
	NSAID (regular dosing, define duration)
	Gabapentinoid (regular dosing, define duration)
	Tramadol prn
	Opioid prn in the event of poorly controlled analgesia

Adapted from NHS “Enhanced Recovery Care Pathways”. VATS, video-assisted thoracic surgery; NSAID, non-steroidal anti-inflammatory drugs.