The management of acute postoperative pain after thoracotomy -one of the most painful procedures- is considered one of the major problems pain specialists are facing today. Many clinicians and researchers are working copiously towards its solution. The present review refers to the methods of preemptive analgesia during thoracotomies and analyzes the latest research efforts on the specific subject, initially, the theoretical model of preemptive analgesia, according to the evolution in pain pathophysiology, is presented. In addition, the different methods of preemptive analgesia in thoracotomies are analyzed. These methods consist of epidural analgesia, intercostals blocks, intrapleural blocks, paravertebral blocks and preoperative systemic administration of opioids and nonsteroidal antiinflammatory drugs. In conclusion, the solution to the problem of acute postoperative post-thoracotomy pain most likely lies to the multi-modal approach to the preemptive analgesia.