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The aim of this systematic review was to update the previous procedure\u2010specific postoperative pain management recommendations for patients undergoing open thoracotomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using previously reported PROSPECT methodology, we performed a systematic review of randomised controlled trials, systematic reviews and meta\u2010analyses evaluating pain interventions for open thoracotomy published between 2015 and 2024. Data extracted from the included studies were evaluated by an expert subgroup that considered the relevance of the studied interventions in clinical practice and their risk\/benefit profile. Recommendations were finalised after review and comments by all members of the PROSPECT working group using a modified Delphi approach. The Cochrane Risk of bias tool 2 was used to grade the quality of evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 100 studies were included. Based on the available evidence, either thoracic epidural analgesia or paravertebral blockade should be provided as a first\u2010line analgesic intervention for open thoracotomy. Erector spinae plane, rhomboid intercostal or intercostal nerve blockade could be used as a second\u2010line regional analgesia intervention. In addition, patients should receive basic analgesia consisting of paracetamol and non\u2010steroidal anti\u2010inflammatory drugs or cyclo\u2010oxygenase\u20102 selective inhibitors. Acupuncture or cryoanalgesia is recommended when regional analgesia cannot be performed, albeit with a low level of supportive evidence. The choice of surgical technique, postoperative physiotherapy and approach to patient education should be based on outcomes other than pain control.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>In these updated guidelines on pain management after open thoracotomy, the main changes concern the recommendation of either thoracic epidural analgesia or paravertebral blockade as the first\u2010line intervention according to patient and clinician preference, combined with basic systemic analgesia. The use of other regional blocks should be limited to patients who cannot receive thoracic epidural analgesia or paravertebral blockade.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/anae.70123","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T08:32:35Z","timestamp":1768206755000},"page":"541-555","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Pain management after open thoracotomy 2025: procedure\u2010specific postoperative pain management (\n                    <scp>PROSPECT<\/scp>\n                    ) recommendations"],"prefix":"10.1111","volume":"81","author":[{"given":"Adrien","family":"Lemoine","sequence":"first","affiliation":[{"name":"Department of Anaesthesia, Intensive Care and Pain Management Oscar Lambret Centre  Lille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Alber","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Intensive Care and Peri\u2010operative Medicine Tenon Hospital  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Girish P.","family":"Joshi","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Pain Management University of Texas Southwestern Medical Centre  Dallas TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Van de Velde","sequence":"additional","affiliation":[{"name":"University of Leuven, Biomedical Sciences Group, Department of Cardiovascular Sciences, University Hospitals of Leuven, Department of Anaesthesiology  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geertrui","family":"Dewinter","sequence":"additional","affiliation":[{"name":"University of Leuven, Biomedical Sciences Group, Department of Cardiovascular Sciences, University Hospitals of Leuven, Department of Anaesthesiology  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Pogatzki\u2010Zahn","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Intensive Care and Pain Medicine University Hospital M\u00fcnster  M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2055-8813","authenticated-orcid":false,"given":"Marie\u2010Pierre","family":"Bonnet","sequence":"additional","affiliation":[{"name":"Sorbonne University Department of Anaesthesiology and Critical Care Medicine, Armand Trousseau Hospital  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the PROSPECT Working Group of the European Society of Regional Anaesthesia and Pain Therapy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000006441"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semtcvs.2013.04.002"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1213\/01.ane.0000333274.63501.ff"},{"key":"e_1_2_10_5_1","unstructured":"Prospect Working Group.Thoracotomy 2015 Summary Recommendations. 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