Thoracotomy with its associated pathophysiological abnormalities produce one of the most damage insult Severe chest wall trauma, damaged peripheral nerves and central nervous system hypersensitivity are implicated as the main causes of post thoractomy pain.Chest wall cannot be immobilized to control this pain, as it must remain in contact motion, indeed vigorous motion, if secretions to be cleared. Additional challenges are that many patients' elderly, may be malnourished, and have coexisting cardiac and respiratory diseases.Many strategies to control this pain have been described, but when the factors influencing its generation are considered, regional anesthesia is the most logical approach.This is because neurogenic pain, which occurs with the the intercostal nerve damage resulting from chest wall trauma. In addition to CNS hyperventilation, its known to be poorly sensitive to opoids, and reliance on these drugs have many detrimental effects, especially on respiration and oxygenation.For optimal effect its better to start the regional anesthesia regimen in the preoperative period and to maintain it after operation for several days until wound healing is established. At the same time, the use of multimode or balanced approach to premedication and postoperative analgesia should be considered.Combination regimens consisting of an effective afferent block, an opoid and non-steroidal anti-inflammatory drug starting in the preoperative and continued in.